| Severe sulfonylurea-induced hypoglycemia: a problem of uncritical prescription and deficiencies of diabetes care in geriatric patients. | |
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MedLine Citation:
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PMID: 20553106 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andreas Holstein; Claude Hammer; Michael Hahn; Nidhi-Su-Ann Kulamadayil; Peter Kovacs |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Expert opinion on drug safety Volume: 9 ISSN: 1744-764X ISO Abbreviation: Expert Opin Drug Saf Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-20 Completed Date: 2011-01-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101163027 Medline TA: Expert Opin Drug Saf Country: England |
Other Details:
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Languages: eng Pagination: 675-81 Citation Subset: IM |
Affiliation:
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Lippe-Detmold Clinic, First Department of Medicine, Röntgenstr. 18, D - 32756 Detmold, Germany. Andreas.Holstein@t-online.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Blood Glucose Self-Monitoring Comorbidity Diabetes Mellitus, Type 2 / drug therapy*, epidemiology Female Germany / epidemiology Glyburide / administration & dosage, adverse effects, pharmacokinetics, therapeutic use Humans Hypoglycemia / chemically induced*, epidemiology Hypoglycemic Agents / administration & dosage, adverse effects*, pharmacokinetics, therapeutic use Inappropriate Prescribing / adverse effects* Incidence Independent Living / statistics & numerical data Kidney Diseases / epidemiology, metabolism Male Metabolic Clearance Rate Middle Aged Nursing Homes / statistics & numerical data Patient Education as Topic Prospective Studies Sulfonylurea Compounds / administration & dosage, adverse effects*, pharmacokinetics, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 0/Sulfonylurea Compounds; 10238-21-8/Glyburide; 33342-05-1/gliquidone; 93479-97-1/glimepiride |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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