title: The clinical course of patients with type 2 diabetes presenting to the hospital with sulfonylurea-induced hypoglycemia.
abstract: BACKGROUND
  This study describes the clinical course of adult patients with type 2 diabetes taking a sulfonylurea and presenting to the hospital with severe hypoglycemia.
  
  
  METHODS
  This was a retrospective chart review of all patients >15 years of age with type 2 diabetes and taking a sulfonylurea who presented to the emergency services of Auckland City Hospital over a 6-year period with severe hypoglycemia.
  
  
  RESULTS
  One hundred eighty-five patients met the inclusion criteria. Their mean ± SD age was 71 ± 11 years, and known duration of diabetes was 14.7 ± 10 years. Of the patients, 167 had micro- and/or macrovascular complications of diabetes, and one-third had had a previous admission with hypoglycemia. Only 61 patients (33%) had a glomerular filtration rate of >60 mL/min. The length of stay was not correlated with admission creatinine level (highest tertile of creatinine, 71 ± 93 h; lowest tertile, 51 ± 79 h). Recurrent in-hospital hypoglycemia occurred in over one-third of patients, and 28 (15%) were re-admitted to the hospital within 28 days of discharge for various reasons, including further hypoglycemia in 13 patients. Two patients died during their admission.
  
  
  CONCLUSIONS
  Patients with type 2 diabetes presenting to the hospital with sulfonylurea-associated hypoglycemia have a high burden of comorbidity, require a long hospital stay, and are at risk of subsequent re-admission to hospital. Careful evaluation of their best future treatment strategies must be undertaken taking account of their comorbidities, including their renal function.
authors.affiliation: 1 Department of Medicine, University of Auckland , Auckland, New Zealand .
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Braatvedt
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Sykes
authors.forename: Zaven
authors.initials: Z
authors.lastname: Panossian
authors.forename: Dianna
authors.initials: D
authors.lastname: McNeill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D015282:Octreotide / Q000627:therapeutic use; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D015282:Octreotide; D013453:Sulfonylurea Compounds; C517652:hemoglobin A1c protein, human