Published online Jul 15, 2021. doi: 10.4239/wjd.v12.i7.1131
Peer-review started: February 8, 2021
First decision: April 20, 2021
Revised: April 28, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: July 15, 2021
Processing time: 153 Days and 22.2 Hours
In healthy people, the lowest daily blood glucose concentration is usually observed in the early morning, after overnight fasting. However, the clinical relevance and the prevalence of fasting biochemical hypoglycemia (FBH) are poorly understood in people who do not have diabetes, although the clinical implications of such hypoglycemia have been extensively studied in patients with diabetes. FBH can be influenced by many factors, including age, sex, body mass, smoking, alcohol drinking, exercise levels, medications, and eating behaviors, such as breakfast skipping and late-night eating.
To determine the prevalence of FBH and investigated its association with potential risk factors in a population without diabetes.
Clinical parameters and lifestyle-related factors were assessed in a cross-sectional study of 695613 people aged 40-74 years who had undergone a health check-up (390282 men and 305331 women). FBH was defined as fasting plasma glucose < 70 mg/dL (3.9 mmol/L) after overnight fasting, regardless of any symptoms. The absence of diabetes was defined as HbA1c < 6.5%, fasting plasma glucose < 126 mg/dL (7.0 mmol/L), and no pharmacotherapy for diabetes. Multivariate logistic regression analysis, with adjustment for confounding factors, was used to identify associations.
FBH was present in 1842 participants (0.26%). There were significantly more women in the FBH group (59.1%) than in the non-FBH group (43.9%). Values of most of the clinical parameters, but not age, were significantly lower in the FBH group than in the non-FBH group. Logistic regression analysis showed that a body mass index of ≤ 20.9 kg/m2 (reference: 21-22.9 kg/m2) and current smoking were significantly associated with FBH, and this was not altered by adjustment for age, sex, and pharmacotherapy for hypertension or dyslipidemia. Female sex was associated with FBH. When the data were analyzed according to sex, men in their 60s or 70s appeared more likely to experience FBH compared with their 40s, whereas men in their 50s and women aged ≥ 50 years appeared less likely to experience FBH. The relationships of FBH with other factors including alcohol drinking and pharmacotherapies for hypertension and dyslipidemia also differed between men and women.
FBH occurs even in non-diabetic people, albeit at a very low frequency. FBH is robustly associated with low body mass and smoking, and its relationship with lifestyle factors varies according to sex.
Core Tip: The clinical relevance of fasting biochemical hypoglycemia (FBH) is poorly understood in people who do not have diabetes. Therefore, we determined the prevalence of FBH and its relationships with other parameters in approximately 700000 people who did not have diabetes. FBH was identified in 0.26% of the participants and women were over-represented among these (59.1%). Low body mass and smoking were associated with FBH in both men and women. Women and men in their 60s and 70s were more likely to experience FBH, and the relationships of FBH with other factors differed between men and women.