Severe sulfonylurea-induced hypoglycemia: a problem of uncritical prescription and deficiencies of diabetes care in geriatric patients.
OBJECTIVE
Severe sulfonylurea-induced hypoglycemia (SH) remains a life-threatening and under-reported condition. We investigated the incidence of SH and clinical characteristics of patients with type 2 diabetes mellitus (T2DM) to demonstrate typical risk constellations.


METHODS
In a prospective population-based observational study, all consecutive cases of SH in the period 2000 - 2009 in a German area with 200,000 inhabitants were registered. Severe hypoglycemia was defined as a symptomatic event requiring treatment with intravenous glucose and was confirmed by a blood glucose measurement of < 50 mg/dl.


RESULTS
A mean incidence of seven episodes of SH per year and 100,000 inhabitants was registered. The 139 hypoglycemic individuals had been treated with glimepiride (n = 98), glibenclamide (n = 40) or gliquidone (n = 1). No preparation showed a constant dose-effect relationship, SH occurring within a wide dose range. The patients were characterized as follows: age 77.5 + or - 9.4 years, duration of diabetes 11 + or - 7 years, body mass index 26.3 + or - 4.9 kg/m(2), HbA1c 6.6 + or - 1.3%, creatinine clearance 46 + or - 24 ml/min with renal insufficiency in 73% and co-medication 7 + or - 3 drugs. Two-thirds of all subjects lived independently at home whereas a third were cared for by a home nursing service or received care in nursing homes. In all, 30% had participated in diabetes education programs. In 31%, systematic blood glucose monitoring was performed.


CONCLUSIONS
Uncritical prescription of sulfonylureas neglecting crucial contraindications - particularly renal insufficiency - and deficiencies of diabetes care contributed substantially to the risk of SH in the mainly geriatric patients. There is a need for alternative therapeutic concepts that minimize the risk of hypoglycemia in geriatric patients with T2DM.
Holstein
Andreas
A
Lippe-Detmold Clinic, First Department of Medicine, Röntgenstr. 18, D - 32756 Detmold, Germany. Andreas.Holstein@t-online.de
Hammer
Claude
C
Hahn
Michael
M
Kulamadayil
Nidhi-Su-Ann
NS
Kovacs
Peter
P
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D005905:Glyburide / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D057970:Inappropriate Prescribing / Q000009:adverse effects*; D015994:Incidence; D057187:Independent Living / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; C057619:glimepiride; C010969:gliquidone; D005905:Glyburide