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Abstract
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 ± 9.4 years, duration of diabetes 11 ± 7 years, body mass index 26.3 ± 4.9 kg/m2, HbA1c 6.6 ± 1.3%, creatinine clearance 46 ± 24 ml/min with renal insufficiency in 73% and co-medication 7 ± 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.
Acknowledgements
The data of this study were obtained within the framework of the dissertations of M Hahn and C Hammer.