title: Sulfonylurea monotherapy and emergency room utilization among elderly patients with type 2 diabetes.
abstract: OBJECTIVE
  In elderly Americans with type 2 diabetes, use of insulin and oral antidiabetic drugs (OADs) accounts for almost one-fourth of drug adverse event-related hospitalizations. It is not clear, however, if sulfonylureas (SUs), frequently prescribed OADs known to cause hypoglycemia, increase the risk of emergency room (ER) visits compared to other OADs. The aim of this study was to compare the emergency room utilization between US elderly patients with diabetes on SU monotherapy vs. other non-SU monotherapies.
  
  
  METHODS
  This retrospective cohort study was conducted using MarketScan(®) database (2009-10) and aimed to evaluate the association between use of SU and ER visits. The analysis included 28,533 patients (aged ≥65 years) receiving SU monotherapy at baseline and 1:1 propensity score (PS)-matched group receiving monotherapy with other OADs. ER utilization was determined during a 1-year follow-up period.
  
  
  RESULTS
  The SU and non-SU groups were overall well balanced after PS matching. The mean (SD) number of ER visits during the follow-up was 0.56 among users of SU users compared to 0.49 (P<0.0001) among non-users. In multivariable analysis, the adjusted odds ratios for ≥2 ER visits were 1.21 (95% CI=1.13-1.30) comparing SU users to non-users and 1.31 (95% CI=1.21-1.41) for SU vs. metformin users.
  
  
  CONCLUSIONS
  Elderly patients with type 2 diabetes on SU monotherapy were more likely to use ER than those on other monotherapies. Further studies are needed to confirm our findings and evaluate other factors associated with ER visits.
authors.affiliation: Merck Research Labs, Merck & Co., Inc., Whitehouse Station, NJ, USA. Electronic address: swapnil.rajpathak@merck.com.
authors.forename: Swapnil N
authors.initials: SN
authors.lastname: Rajpathak
authors.affiliation: Merck Research Labs, Merck & Co., Inc., Whitehouse Station, NJ, USA.
authors.forename: Chunmay
authors.initials: C
authors.lastname: Fu
authors.affiliation: Merck Research Labs, Merck & Co., Inc., Whitehouse Station, NJ, USA.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Brodovicz
authors.affiliation: Merck Research Labs, Merck & Co., Inc., Whitehouse Station, NJ, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Engel
authors.affiliation: The James L. Winkle College of Pharmacy, University of Cincinnati, OH, USA.
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Heaton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: Diabetes; Elderly; Emergency room; Monotherapy; Sulfonylureas