Brief report
Sulphonyurea as a cause of severe hypoglycaemia in the community

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Abstract

Introduction

Hypoglycaemia is a well recognised side effect of insulin and sulphonyurea therapy in the treatment of, patients with diabetes mellitus.

Methods

We performed a retrospective analysis of patients who developed severe hypoglycaemia in Hull and, East Yorkshire, United Kingdom over a 4-month period to assess the different therapies that contribute the most to the problem and the patient groups who are at greatest risk.

Results

Of the 75 patients with diabetes mellitus who developed severe hypoglycaemia, 61 (80%) were taking, insulin, 5 in combination with metformin. Ten (13%) patients were taking SU therapy; 5 in, combination with metformin, 2 in combination with a thiazolidinedione and 1 in combination with, insulin. When the SU-treated and non-SU treated groups were compared, patients taking SU therapy were, significantly older and had significantly lower HbA1c levels.

Conclusions

All patients taking SU and insulin treatment are potentially at risk of developing hypoglycaemia. Our, analysis shows that almost 15% of patients in our region who suffered from severe hypoglycaemia, were on SU therapy. Patients in this group were older and had lower levels of HbA1c. Whilst national HbA1c targets may be useful for clinicians to define glycaemic targets for their, population, this has to be tempered by what is in the best interests of the patient and not what is, dictated by the Quality and Outcomes Framework. Possible alternatives to SU therapy should be, considered especially if hypoglycaemia is a concern.

Introduction

Hypoglycaemia is a well recognised side effect of insulin and sulphonyurea therapy in the treatment of patients with diabetes mellitus. Recent National Institute for Health and Clincial Excellence (NICE) clinical guidelines recommend that patients with Type 2 Diabetes Mellitus (T2DM) are given advice regarding hypoglycaemia when starting insulin or sulphonylurea (SU) therapy [1]. SU and insulin therapy have been associated with an increased risk of hypoglycaemia particularly in a population who have tight glycaemic control [2], [3]. We performed a retrospective analysis of patients who developed severe hypoglycaemia in Hull and East Yorkshire, United Kingdom over a 4-month period to assess the different therapies that contribute the most to the problem and the patient groups who are at greatest risk.

Section snippets

Methods

All episodes of hypoglycaemia which involve the ambulance service in our Trust are reported to the local diabetes service within 72 h with patient consent. Hypoglycaemic episodes that occur in the hospital A&E are fed back within 72 h to enable rapid patient review and follow up. We included all reported episodes of severe hypoglycaemia from these sources over the period of December 2008 to March 2009 inclusive. We defined severe hypoglycaemia in this case as any hypoglycaemic event that required

Results

A total of 76 patients suffered severe hypoglycaemia over the 4-month study period. Seventy-three episodes occurred at patient's residences (i.e. home, residential home, etc.) whilst 3 episodes occurred outside. There were no other serious adverse events associated with the hypoglycaemic event. The median age of patients was 63 years (IQR 43–78 years); 40 were male and 36 female. The median HbA1c was 8.1 ± 0.3 SE%. Thirty-one (40.7%) patients had type 1 diabetes (T1DM) and 33 (43.4%) had T2DM. In

Discussion

It has been suggested that a lower HbA1c may increase an individual's risk of cardiac death [4], particularly in the later stages of their disease. In addition, the risk: benefit of tight glycaemic control appears to potentially favour risk in those aged 75 or more [5] in terms of falls and may not improve life expectancy [6] or quality of life. The personal as well as the financial cost associated with morbidity secondary to severe hypoglycaemia must also be considered.

Whilst national HbA1c

Conflict of interest

None to declare.

References (6)

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    Symptomatic hypoglycemia in NIDDM patients treated with oral hypoglycemic agents

    Diabetes Care

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There are more references available in the full text version of this article.

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