title: Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes.
abstract: OBJECTIVE
  To determine whether temporal patterns of hypoglycaemia exist in inpatients with diabetes 'at risk' of hypoglycaemia (those on insulin and/or sulfonylureas), and if so whether patterns differ between hospitals and between these treatments.
  
  
  METHODS
  Retrospective multicentre audit of inpatients with diabetes involving 11 acute UK National Health Service (NHS) trusts.
  
  
  METHODS
  Capillary blood glucose readings of 3.9 mmol/L or less (hypoglycaemia) for all adult (≥18 years) inpatients with diabetes 'at risk' of hypoglycaemia were extracted from the Abbott PrecisionWeb Point-of-Care Data Management System over a 4-week period. Overall, 2521 readings of 3.9 mmol/L or less (hypoglycaemia) occurring in 866 participants between 1 June 2013 and 29 June 2013 were analysed.
  
  
  RESULTS
  The majority (65%) occurred between 21:00 and 08:59, a pattern common to all Trusts. This was more frequent in sulfonylurea-treated than insulin-treated participants (75.3% vs 59.3%, p=0.0001). Furthermore, hypoglycaemic readings were more frequent between 5:00 and 7:59 in sulfonylurea-treated than insulin-treated participants (46.7% vs 22.7% of readings for respective treatments, p=0.0001). Sulfonylureas accounted for 31.8% of all hypoglycaemic readings. As a group, sulfonylurea-treated participants were older (median age 78 vs 73 years, p=0.0001) and had lower glycated haemoglobin (median 56 (7.3%) vs 69 mmol/mol (8.5%), p=0.0001). Hypoglycaemic readings per participant were as frequent for sulfonylurea-treated participants as for insulin-treated participants (median=2 for both) as were the proportions in each group with ≥5 hypoglycaemic readings (17.3% vs 17.7%).
  
  
  CONCLUSIONS
  In all Trusts, hypoglycaemic readings were more frequent between 21:00 and 08:59 in 'at risk' inpatients with diabetes, with a greater frequency in the early morning period (5:00-7:59) in sulfonylurea-treated inpatients. This may have implications for the continuing use of sulfonylureas in the inpatient setting.
authors.affiliation: Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajendran
authors.affiliation: Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kerry
authors.affiliation: Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: Rayman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds
keywords: DIABETES & ENDOCRINOLOGY; INTERNAL MEDICINE