Characteristics and mortality of type 2 diabetic patients hospitalized for severe iatrogenic hypoglycemia
ABSTRACT Severe hypoglycemia can be dramatic in diabetic patients, but its long-term outcome is unknown. We aimed to describe clinical characteristics of type 2 diabetic patients hospitalized for iatrogenic hypoglycemia, and find predictors of long-term mortality, with a special regard to anti-hyperglycemic regimens.
We retrospectively analyzed 126 episodes of severe hypoglycemia in type 2 diabetic patients. We collected data on the event (coma, pre-hospital fall, glucose level, duration of hypoglycemia), concomitant risk factors, diabetic complications and chronic comorbidities. We divided patients according to the use of insulin or oral agents (OHAs). In-hospital outcomes were acute coronary syndrome (ACS) and duration of hospitalization. We finally assessed long-term mortality.
Hypoglycemia due to OHA was associated with higher prevalence of coma and longer duration than hypoglycemia due to insulin. OHA use was also associated with a longer hospital stay, but no increase in the incidence of ACS. Overall mortality after a 2-year median follow-up was 42.1%. Despite the apparent worse presentation of hypoglycemic episodes associated with OHA use, this did not lead to an increased long-term mortality.
Severe iatrogenic hypoglycemia in OHA-treated patients has a worse presentation, but is not associated with a higher long-term mortality than in insulin-treated patients.
Médecine des Maladies Métaboliques 09/2011; 5(4):357–358. DOI:10.1016/S1957-2557(11)70264-4
Medicina Interna de Mexico 08/2014; 2014(30):407-418.
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ABSTRACT: The prevalence of elderly persons with type 2 diabetes mellitus (T2DM) is progressively growing. Often associated with disabilities/comorbidities, T2DM lowers the chances of successful aging and is independently associated with frailty and increased risk of hypoglycemia, which can be further exacerbated by anti-hyperglycemic treatment. In this perspective, the clinical management of T2DM in the elderly is challenging and requires individualization of optimal glycemic targets depending on co-morbidities, cognitive functioning, and ability to recognize and self-manage the disease. The lack of solid evidence-based medicine supporting treatment guidelines for older people with diabetes further complicates the matter. Several classes of medicine for the treatment of T2DM are currently available and different drug combinations are often required to achieve individualized glycemic goals. Many of these drugs, however, carry disadvantages such as the propensity to cause weight gain or hypoglycemia. The DPP-4 inhibitors (DPP4-I), a recent addition to the pharmacological armamentarium, have become widely accepted in clinical practice because of their efficacy, low risk of hypoglycemia, neutral effect on body weight, and apparently greater safety in patients with kidney failure. Although more information is needed to reach definitive conclusions, growing evidence suggests that DPP4-I may become a valuable component in the pharmacologic management of elderly persons with T2DM. This review aims to delineate the potential advantages of this pharmacologic approach in the treatment of elderly people with T2DM.Diabetes Obesity and Metabolism 05/2014; 17(2). DOI:10.1111/dom.12319 · 5.46 Impact Factor