Drug-Induced Hypoglycemic Coma in 102 Diabetic Patients

Ben-Ami, Haim; Nagachandran, Pradeep; Mendelson, Ayelet; Edoute, Y

doi:10.1001/archinte.159.3.281

Cited by 183 publications

(120 citation statements)

References 45 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Second, physicians often perceive hyperglycemia as a consequence of stress and acute illness and often delay treatment until blood glucose levels exceed 200 mg/dl (2,21). Third, fear of hypoglycemia constitutes a major barrier to efforts to improve glycemic control, especially in patients with poor caloric intake (5,22). Finally, physicians frequently hold their patient's previous outpatient antidiabetes regimen and initiate sliding-scale coverage with regular insulin, a practice associated with limited therapeutic success and suboptimal glycemic control (16,17,23,24).…”

Section: B Sliding Scale Regimen With Regular Insulinmentioning

confidence: 99%

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

et al. 2007

View full text Add to dashboard Cite

OBJECTIVE -We sought to study the optimal management of hyperglycemia in nonintensive care unit patients with type 2 diabetes, as few studies thus far have focused on the subject.RESEARCH DESIGN AND METHODS -We conducted a prospective, multicenter, randomized trial to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with type 2 diabetes. A total of 130 insulin-naive patients were randomized to receive glargine and glulisine (n ϭ 65) or a standard SSI protocol (n ϭ 65). Glargine was given once daily and glulisine before meals at a starting dose of 0.4 units ⅐ kg Ϫ1 ⅐ day Ϫ1 for blood glucose 140 -200 mg/dl or 0.5 units ⅐ kg Ϫ1 ⅐ day Ϫ1 for blood glucose 201-400 mg/dl. SSI was given four times per day for blood glucose Ͼ140 mg/dl. RESULTS -The mean admission blood glucose was 229 Ϯ 6 mg/dl and A1C 8.8 Ϯ 2%. A blood glucose target of Ͻ140 mg/dl was achieved in 66% of patients in the glargine and glulisine group and in 38% of those in the SSI group. The mean daily blood glucose between groups ranged from 23 to 58 mg/dl, with an overall blood glucose difference of 27 mg/dl (P Ͻ 0.01). Despite increasing insulin doses, 14% of patients treated with SSI remained with blood glucose Ͼ240 mg/dl. There were no differences in the rate of hypoglycemia or length of hospital stay.CONCLUSIONS -Treatment with insulin glargine and glulisine resulted in significant improvement in glycemic control compared with that achieved with the use of SSI alone. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the management of non-critically ill, hospitalized patients with type 2 diabetes. Diabetes Care 30:2181-2186, 2007H yperglycemia in hospitalized patients is a common, serious, and costly health care problem with profound medical consequences. Increasing evidence indicates that the development of hyperglycemia during acute medical or surgical illness is not a physiologic or benign condition but is a marker of poor clinical outcome and mortality (1-3). Extensive evidence from observational studies, including our own, indicates that in hospitalized patients with critical illness, hyperglycemia is associated with an increased risk of complications and mortality (3-9). Prospective randomized trials in critically ill patients have shown that intensive glucose control reduces the risk of multiorgan failure, systemic infections, and short-and longterm mortality. Effective management of hyperglycemia is also associated with a decreased length of intensive care unit and hospital stay (4,6,8 -10) and decreased total hospitalization cost (11). The importance of glycemic control on outcome is not limited to patients in critical care areas but also applies to patients admitted to general surgical and medical wards. In such patients, the presence of hyperglycemia has been associated with prolonged hospital stay, infection, disability after hospital discharge, and death (1,5,12). In general surgery patients, the relative risk for serious postopera...

show abstract

Section: B Sliding Scale Regimen With Regular Insulinmentioning

confidence: 99%

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Furthermore, the incidence of adverse events in renally impaired patients who received repaglinide was comparable to that in patients with normal renal function. These are important endorsements of the safety of this agent in a group of patients who are often in need of enhanced metabolic control but who are also often at risk for hypoglycemia due to (often unknown) renal impairment on the other side (14).…”

Section: Conclusion -No Relationshipmentioning

confidence: 99%

Safety and Efficacy of Repaglinide in Type 2 Diabetic Patients With and Without Impaired Renal Function

Hasslacher¹

2003

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE -To evaluate the influence of renal impairment on the safety and efficacy of repaglinide in type 2 diabetic patients. RESEARCH DESIGN AND METHODS -This multinational, open-label study comprised a 6-week run-in period, continuing prestudy antidiabetic medication, followed by a titration period (1-4 weeks) and a 3-month maintenance period. Patients with normal renal function (n ϭ 151) and various degrees of renal impairment (n ϭ 130) were treated with repaglinide (maximal dose of 4 mg, three times daily). Safety and efficacy assessments were performed at baseline (end of run-in) and at the end of study treatment.RESULTS -The type and severity of adverse events during repaglinide treatment were similar to the run-in period. The number of patients with adverse events was not significantly related to renal function during run-in or repaglinide treatment. Percentage of patients with hypoglycemic episodes increased significantly (P ϭ 0.007) with increasing severity of renal impairment during run-in but not during repaglinide treatment (P ϭ 0.074). Metabolic control (HbA 1c and fasting blood glucose) with repaglinide was unchanged from that on previous antidiabetic medication. Final repaglinide dose tended to be lower for patients with severe and extreme renal impairment than for patients with less severe renal impairment or normal renal function (P ϭ 0.032).CONCLUSIONS -Repaglinide has a good safety and efficacy profile in type 2 diabetic patients complicated by renal impairment and is an appropriate treatment choice, even for individuals with more severe degrees of renal impairment.

show abstract

“…Death occur in 5 patients(4.9%). 70 A prospective one year study found sixty five of 125 (52%) admissions for hypoglycemia presented with obtundation, stupor or coma. 29 While the length of time in coma could not always be determined, the one death related to hypoglycemia occurred in a patient with coma lasting over 20 hours.…”

Section: Hypoglycemic Comamentioning

confidence: 99%