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Risk of severe hypoglycemia in sulfonylurea‐treated patients from diabetes centers in Germany/Austria: How big is the problem? Which patients are at risk?
Author(s) -
Schloot Nanette C.,
Haupt Axel,
Schütt Morten,
Badenhoop Klaus,
Laimer Markus,
Nicolay Claudia,
Reaney Matthew,
Fink Katharina,
Holl Reinhard W.
Publication year - 2016
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2722
Subject(s) - sulfonylurea , hypoglycemia , diabetes mellitus , medicine , intensive care medicine , endocrinology
Background We investigated the rate of severe hypoglycemic events and confounding factors in patients with type 2 diabetes treated with sulfonylurea at specialized diabetes centers, documented in the German/Austrian DPV–Wiss database. Methods Data from 29 485 sulfonylurea‐treated patients were analyzed (median[IQR] age 70.8[62.2–77.8] years, diabetes duration 8.2[4.3–12.8] years). The primary objective was to estimate the event rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency hospitalization). Secondary objectives included exploration of confounding risk factors through group comparison and Poisson regression. Results Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of sulfonylurea treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event rate of severe hypoglycemia [95%CI] was 3.9[3.7–4.2] events/100 patient‐years (coma: 1.9[1.8–2.1]; hospitalization: 1.6[1.5–1.8]). Adjusted event rates by diabetes treatment were 6.7 (sulfonylurea + insulin), 4.9 (sulfonylurea + insulin + other OAD), 3.1 (sulfonylurea + other OAD) and 3.8 (sulfonylurea only). Patients with ≥1 severe event were older ( p < 0.001) and had longer diabetes duration ( p = 0.020) than patients without severe events. Participation in educational diabetes‐programs and indirect measures of insulin‐resistance (increased BMI, plasma‐triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common ( n = 3113 eGFR; ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30‐60 mL/min: 4.8; >60 mL/min: 3.9). Conclusions These real‐life data showed a rate of severe hypoglycemia of 3.9/100 patient‐years in sulfonylurea‐treated patients from specialized diabetes centers. Higher risk was associated with known risk factors including lack of diabetes education, older age and decreased eGFR but also with lower BMI and lower triglyceride levels, suggesting that sulfonylurea treatment in those patients should be considered with caution. Copyright © 2015 John Wiley & Sons, Ltd.