Severe hypoglycemia in an elderly patient treated with metformin

Zitzmann, S; Ir, Reimann; Schmechel, H

doi:10.5414/cpp40108

Cited by 29 publications

(17 citation statements)

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“…However, this required both participant reporting of the need for assistance and third party confirmation. Cases of severe hypoglycaemia in people on metformin (monotherapy) have previously been reported in the literature . Furthermore, for non‐severe hypoglycaemia, a recent model‐based meta‐analysis of trial data suggests a small increased risk for both metformin (RR ~2.0) and GLP1‐RAs (RR up to 3.1), compared with placebo …”

Section: Discussionmentioning

confidence: 96%

Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Dunkley

Fitzpatrick

Gray

et al. 2019

Diabetes Obesity Metabolism

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Aims To determine the incidence and severity of self‐reported hypoglycaemia in a primary care population with type 2 diabetes. The study also aimed to compare incidence by treatment regimen. Materials and methods A prospective observational study in 17 centres throughout the UK was conducted. Recruitment was based on treatment regimen (metformin alone, sulphonylurea‐, insulin‐ or incretin‐based therapy). Participants were asked to keep a blood glucose diary and self‐report hypoglycaemia episodes [non‐severe (self‐treated) and severe (requiring external help)] over a 12‐month period. Results Three hundred and twenty‐five participants were enrolled, of whom 274 (84%) returned ≥1 monthly diaries. Overall, 39% reported experiencing hypoglycaemia; 32% recorded ≥1 symptomatic, 36% ≥1 non‐severe, and 7% ≥1 severe episodes. By treatment, incidence (events per person/year) for any hypoglycaemia type was 4.39 for insulin, 2.34 for sulphonylurea, 0.76 for metformin, and 0.56 for incretin‐based therapy. Compared with metformin, risk of non‐severe hypoglycaemia was ~3 times higher for participants on sulphonylureas and > 5 times higher for those on insulin [incidence rate ratio (IRR) 3.02 (1.76‐5.18), P < 0.001, and IRR 5.96 (3.48‐10.2), P < 0.001, respectively]. For severe episodes, the incidence for sulphonylurea (0.09) was similar to metformin (0.07) and incretin‐based therapy (0.07); for insulin the risk remained almost 5 times higher than metformin [incidence 0.32; IRR 4.55 (1.28‐16.20), P = 0.019]. Conclusions Hypoglycaemia represents a substantial burden for people with type 2 diabetes. Sulphonylureas and insulin are both associated with a risk of reported non‐severe hypoglycaemia, but only insulin with severe episodes. This suggests the importance of the continued use of sulphonylureas in appropriate patients with type 2 diabetes.

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Section: Discussionmentioning

confidence: 96%

Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Dunkley

Fitzpatrick

Gray

et al. 2019

Diabetes Obesity Metabolism

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“…In some cases physical activity as in the current case, and nutritional deprivation, (presumably causing low hepatic glycogen stores), have also been associated. 8 Beta-blockade therapy may impair the counterregulatory response to hypoglycaemia, 15 and such intercurrent therapy may also have contributed to the development of this patient's hypoglycaemia. Higher range doses of metformin may be more likely to be associated with hypoglycaemia, 8 although it is reported that the maximal glucose-lowering efficacy of the drug is usually achieved at about 2,000 mg/day.…”

Section: Discussionmentioning

confidence: 99%

Exercise, metformin and hypoglycaemia: a neglected entity

Omari

Yue

Twigg

2005

Diabetes & Vascular Disease

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W e describe a case of hypoglycaemia induced by exercise in a patient with type 2 diabetes taking metformin, who was not taking insulin or sulphonylurea medication. The hypoglycaemia resolved after the dosage of metformin was reduced, despite increased physical activity. A brief review of the literature identifying the frequency of and risk factors for hypoglycaemia during treatment with metformin is discussed.

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“…Some patients may be mistaken and accidentally take inappropriate doses of medications, or undergo concurrent disorders that increase the bioavailability of the drug. Though metformin cannot induce hypoglycaemia, as confirmed by the expert consensus (Cryer et al 2009), it has been reported to cause severe hypoglycaemia in the 1995 UK prospective diabetes study (Cryer et al 2009) and in an elderly patient (Zitzmann et al 2002). Thiazolidine-diones, alphaglucosidase inhibitors, GLP1-receptor agonists and dipeptidyl peptidase IV inhibitors do not induce hypoglycaemia themselves but increase the risk of hypoglycaemia when combined with an insulin secretagogue or insulin.…”

Section: Medications Known To Be Used By the Patientmentioning

confidence: 94%