Severe Sulfonylurea-Induced Hypoglycemia: A Problem of Uncritical Prescription and Deficiencies of Diabetes Care in Geriatric Patients

Expert Opin Drug Saf. 2010 Sep;9(5):675-81. doi: 10.1517/14740338.2010.492777.

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 + 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Blood Glucose Self-Monitoring
  • Comorbidity
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Germany / epidemiology
  • Glyburide / administration & dosage
  • Glyburide / adverse effects
  • Glyburide / pharmacokinetics
  • Glyburide / therapeutic use
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / epidemiology
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / pharmacokinetics
  • Hypoglycemic Agents / therapeutic use
  • Inappropriate Prescribing / adverse effects*
  • Incidence
  • Independent Living / statistics & numerical data
  • Kidney Diseases / epidemiology
  • Kidney Diseases / metabolism
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Nursing Homes / statistics & numerical data
  • Patient Education as Topic
  • Prospective Studies
  • Sulfonylurea Compounds / administration & dosage
  • Sulfonylurea Compounds / adverse effects*
  • Sulfonylurea Compounds / pharmacokinetics
  • Sulfonylurea Compounds / therapeutic use

Substances

  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • glimepiride
  • gliquidone
  • Glyburide