Determinants of hypoglycemia and hospitalization among hemodialysis patients with type 2 diabetes: insights from a multicenter study in a resource-limited healthcare system

This multicenter cross‑sectional study investigated the incidence of hypoglycemia and hospitalization among patients with type 2 diabetes mellitus (T2DM) receiving maintenance hemodialysis (HD) and identified their associated factors. Adults with T2DM on HD for at least three months were enrolled using a census approach. Data on sociodemographic, clinical, treatment, and laboratory variables were collected through structured interviews and medical record review. Among 311 patients (mean age 63.8 ± 8.7 years; 57.2% male), 56.6% reported at least one hypoglycemic episode, with a mean of 77.9 ± 174.1 episodes since diagnosis. Hospitalization after starting HD was reported by 65.3%, with a mean of 3.9 ± 4.4 admissions. Each additional HD year increased the odds of hypoglycemia by 30% (OR = 1.3, 95% CI: 1.0-1.5, <i>p</i> = 0.018), and adherence to unadjusted insulin regimens tripled the risk (OR = 3.0, 95% CI: 1.0-8.8, <i>p</i> = 0.041). Each extra year of HD increased odds of hospitalization by 50% (OR = 1.5, 95% CI: 1.1-2.0, <i>p</i> = 0.013), while higher hemoglobin (per 1 g/dL) reduced odds by 30% (OR = 0.7, 95% CI: 0.5-1.0, <i>p</i> = 0.044) and higher serum calcium (per 1 mg/dL) reduced odds by 70% (OR = 0.3, 95% CI: 0.1-0.6, <i>p</i> = 0.002). A history of hypoglycemia was also linked to more than threefold higher odds of hospitalization (OR = 3.4, 95% CI: 1.2-9.3, <i>p</i> = 0.018). These findings support targeted monitoring, individualized glycemic management, and correction of anemia and mineral imbalances to reduce preventable complications.