Symptomatic Hypoglycemia in NIDDM Patients Treated With Oral Hypoglycemic Agents

Am, Jennings; Rm, Wilson; Ward, J. D.

doi:10.2337/diacare.12.3.203

Cited by 183 publications

(76 citation statements)

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“…In contrast, metformin (odds ratio 1.42) was associated with only a small relative risk elevation, as reported previously (1,9). The proportion of patients developing documented hypoglycemia in our study population was similar to previous studies (9,11), although reported frequencies varied substantially (0 -73,000 per 100,000 person-years) (7,11,21). In our study, hypoglycemia had to be severe enough to lead to a GP or hospital visit, while minor events may have been missed.…”

Section: Hypoglycemiasupporting

confidence: 89%

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

et al. 2008

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OBJECTIVE -Lactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEARCH DESIGN AND METHODS-This study is a nested case-control analysis using the U.K.-based General Practice Research Database to identify patients with type 2 diabetes who used oral antidiabetes drugs. Within the study population, all incident cases of lactic acidosis and hypoglycemia were identified, and hypoglycemia case subjects were matched to up to four control patients based on age, sex, practice, and calendar time.RESULTS -Among the study population of 50,048 type 2 diabetic subjects, six cases of lactic acidosis during current use of oral antidiabetes drugs were identified, yielding a crude incidence rate of 3.3 cases per 100,000 person-years among metformin users and 4.8 cases per 100,000 person-years among users of sulfonylureas. Relevant comorbidities known as risk factors for lactic acidosis could be identified in all case subjects. A total of 2,025 case subjects with hypoglycemia and 7,278 matched control subjects were identified. Use of sulfonylureas was associated with a materially elevated risk of hypoglycemia. The adjusted odds ratio for current use of sulfonylureas was 2.79 (95% CI 2.23-3.50) compared with current metformin use.CONCLUSIONS -Lactic acidosis during current use of oral antidiabetes drugs was very rare and was associated with concurrent comorbidity. Hypoglycemic episodes were substantially more common among sulfonylurea users than among users of metformin.

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Section: Hypoglycemiasupporting

confidence: 89%

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

et al. 2008

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“…A study (75) in England of 219 people with type 2 diabetes treated with sulfonylureas and/or metformin observed that 20% of those taking sulfonylureas had experienced symptoms of hypoglycemia in the preceding 6 months. In Atlanta, a 6-month, retrospec- tive, cross-sectional survey of 1,055 predominantly female, African-American patients with type 2 diabetes, treated with oral antidiabetic drugs or insulin, completed serial questionnaires to estimate the frequency of hypoglycemia (76).…”

Section: Frequency Of Hypoglycemia In Type 2 Diabetes -Mild Hypoglycementioning

confidence: 99%

Hypoglycemia in Type 2 Diabetes

2005

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“…Early estimates of the incidences of symptomatic hypoglycaemia associated with sulphonylureas varied greatly Ð from 19 to 404 events per 1000 patient-years. 7,8 Recent data, from the UKPDS, showed that 30% of patients treated with glibenclamide reported symptomatic hypoglycaemia during the ®rst year of therapy Ð the same incidence as was experienced among insulin-treated patients. 2 With time, the incidence of hypoglycaemia decreased with sulphonylurea therapy, but so too did glycaemic control, an observation that could be taken to imply a causal relationship.…”

Section: Drug-induced Hypoglycaemia In Type 2 Diabetes: How Common?mentioning

confidence: 96%

Review of prandial glucose regulation with repaglinide: a solution to the problem of hypoglycaemia in the treatment of Type 2 diabetes?

Nattrass

Lauritzen

2000

Int J Obes

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Type 2 diabetes mellitus is characterised by abnormal beta-cell function (present at the time of diagnosis) that is often associated with insulin resistance. An important and consistent pathophysiological ®nding is the failure to produce adequate increments in insulin secretion in response to carbohydrate intake. Therefore, insulin secretagogue therapy, particularly when focused on prandial glucose regulation, is a logical approach to treatment because it addresses one of the most fundamental pathophysiological aspects of the disease. However, the traditional secretagogues Ð the sulphonylureas Ð have long been associated with the unwanted effect of hypoglycaemia. This is particularly likely to occur when drugs with lengthy plasma half-lives, prolonged drug ± receptor interactions, active metabolites or a reliance on renal clearance are used. The problem is most prevalent in elderly patients, where sulphonylurea-induced hypoglycaemia may be related to failure to comply with strict mealtimes or the need for supplementary food intake, often in the context of compromised renal function. Data from large-scale outcome studies demonstrate that when tight glycaemic control is achieved through aggressive antidiabetic therapy, late diabetic complications can be signi®cantly reduced. However, the pursuit of stricter HbA lc targets with more aggressive interventions may increase the risk of hypoglycaemia. This is an irony because the clinical need to avoid hypoglycaemia and patients' apprehension of it present barriers to the achievement of bene®cial glycaemic targets. However, an increased risk of hypoglycaemia may not be inevitable with insulin secretagogue therapy. The recently introduced carbamoylmethyl benzoic acid derivative, repaglinide, has pharmacological properties that are well suited to its intended role as a prandial glucose regulator. When taken prior to main meals, the rapid onset and relatively short duration of action of repaglinide aid disposal of the mealtime glucose load, without continued stimulation of pancreatic beta-cells in the postprandial fasting period. Repaglinide is also characterised by hepatic metabolism and elimination, which is an advantage in the context of impaired renal function. Prandial glucose regulation with repaglinide selectively increases insulin secretion, and hence limits glucose excursions, in the prandial phase. If a meal is omitted, so too is the corresponding dose. This more¯exible approach to the management of Type 2 diabetes has a number of advantages when compared with the ®xed daily dosing regimens of sulphonylureas, among them a reduced risk of hypoglycaemia Ð a bene®t that is particularly marked in the context of missed or irregular meals.

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Symptomatic Hypoglycemia in NIDDM Patients Treated With Oral Hypoglycemic Agents

Cited by 183 publications

References 0 publications

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

Hypoglycemia in Type 2 Diabetes

Review of prandial glucose regulation with repaglinide: a solution to the problem of hypoglycaemia in the treatment of Type 2 diabetes?

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