Brief reportSulphonyurea as a cause of severe hypoglycaemia in the community
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.
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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.
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