Hypoglycemia is a serious adverse effect in the pharmacological treatment of Type 2 diabetes mellitus (T2DM), exacerbated by comorbidities that affect drug metabolism and clearance. This report describes a case involving a 61-year-old man with hypertension and T2DM. The patient experienced hypoglycemia while taking a combination of voglibose and metformin hydrochloride. His condition was further complicated by urosepsis, acute-on-chronic kidney disease, and hydroureteronephrosis calculi, which likely altered drug clearance and pharmacokinetics. This condition increased his risk of hypoglycemia. Effective management required close monitoring of blood glucose levels and adjustments to the treatment regimen, considering his renal impairment. This case highlights the risks associated with combination therapy in patients with renal issues and underscores the importance of personalized treatment plans, vigilant glucose monitoring, and consideration of renal function to reduce the risk of drug-induced hypoglycemia in patients with T2DM and comorbidities.

1. International Diabetes Federation. IDF Diabetes Atlas. 9^th ed. Brussels, Belgium: International Diabetes Federation; 2019. Available from: https://www.diabetesatlas.org [Last accessed on 2023 May 30].

2. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi: 10.2337/dc21-S002

3. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: Update to a position statement of the American diabetes association and the European association for the study of diabetes. Diabetes Care. 2015;38(1):140-149. doi: 10.2337/dc14-2441

4. Li T, Providencia R, Mu N, et al. Association of metformin monotherapy or combined therapy with cardiovascular risks in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2021;20(1):30. doi: 10.1186/s12933-020-01202-5

5. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-1395. doi: 10.2337/dc12-2480

6. Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi, T. Diabetic kidney disease: World wide difference of prevalence and risk factors. J Nephropharmacol. 2015;5(1):49-56.

7. De Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 2011;305(24):2532-2539. doi: 10.1001/jama.2011.861

8. Getachew H, Tadesse Y, Shibeshi W. Drug dosage adjustment in hospitalized patients with renal impairment at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC Nephrol. 2015;16:158. doi: 10.1186/s12882-015-0155-9

9. Oh TJ, Yu JM, Min KW, et al. Efficacy and safety of voglibose plus metformin in patients with type 2 diabetes mellitus: A randomized controlled trial. Diabetes Metab J. 2019;43(3):276-286. doi: 10.4093/dmj.2018.0051

10. DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism. 2016;65(2):20-29. doi: 10.1016/j.metabol.2015.10.014

11. Zhao X, Wang M, Wen Z, et al. GLP-1 receptor agonists: Beyond their pancreatic effects. Front Endocrinol. 2021;12:721135. doi: 10.3389/fendo.2021.721135

12. Moon H, Ro SW. MAPK/ERK signaling pathway in hepatocellular carcinoma. Cancers. 2021;13(12):3026. doi: 10.3390/cancers13123026

13. Wang Y, Yang L, Chen T, et al. A novel lncRNA MCM3AP-AS1 promotes the growth of hepatocellular carcinoma by targeting miR-194-5p/FOXA1 axis. Mol Cancer. 2019;18(1):28. doi: 10.1186/s12943-019-0957-7

14. American Diabetes Association. Standards of medical care in diabetes-2018 abridged for primary care providers. Clin Diabetes. 2018;36(1):14-37. doi: 10.2337/cd17-0119

15. Chan JC, Malik V, Jia W. Diabetes in Asia: Epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129-2140. doi: 10.1001/jama.2009.726