Hypoglycaemia requiring medical assistance in patients with diabetes: A prospective multicentre survey in tertiary hospitals

Liatis, Stavros; Mylona, Maria; Kalopita, Stavroula; Papazafiropoulou, Athanasia; Karamagkiolis, S.; Μelidonis, Αndreas; Xilomenos, Apostolos; Ioannidis, Ioannis; Kaltsas, Gregory; Lanaras, Leonidas; Papas, S.; Basagiannis, Christos; Kokkinos, Alexander

doi:10.1016/j.diabet.2014.10.006

Cited by 14 publications

(17 citation statements)

References 28 publications

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“…[6,14,16,25] Thus, due to the massive socioeconomic burden associated with HMA, the present study attempted to identify additional HMA-related risk factors using patients with NSH as control subjects, which is in significant contrast to previous studies that used nonhypoglycemic patients as control subjects. [6,15,16] As mentioned above, the control group in this study included patients who visited outpatient diabetic clinics during the same time period as when the HMA patients were recruited and were confirmed as having NSH based on SMBG reports. Furthermore, we assessed information regarding socioeconomic status and laboratory results at the time of hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported a lower usage rate of insulin than oral medications alone in the HMA group. [15,41–43] The development of severe hypoglycemia as a result of sulfonylurea use may occur frequently because sulfonylurea, an oral hypoglycemic agent that can cause severe hypoglycemia, is prescribed more often than is insulin. [31,44–46] Based on our results, it is necessary to test for hypoglycemia in sulfonylurea-treated patients.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Jeon

Kim

et al. 2016

Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Jeon

Kim

et al. 2016

Medicine

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“… 7 Visits to the ED because of hypoglycemia requiring medical assistance were evaluated in a recent prospective multicenter survey in tertiary hospitals in Greece: most cases (90.8%) were observed in patients with T2DM, and use of sulfonylureas was the strongest independent predictor (OR: 4.0; 95% CI: 2.5; 6.4) of these events. 30 It is therefore essential to know the real incidence of hospital admissions and EV for hypoglycemia with different antidiabetic drugs, and to the best of our knowledge, this study is the first to investigate this question in France with documented events in the National Health Insurance database. The current EGB analysis shows meaningful reductions in the frequency of the most severe hypoglycemic episodes when patients were treated with DPP4-is as compared to IS drugs.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia hospitalization frequency in patients with type 2 diabetes mellitus: a comparison of dipeptidyl peptidase 4 inhibitors and insulin secretagogues using the French health insurance database

Detournay¹,

Halimi²,

Robert³

et al. 2015

VHRM

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AimWe aimed to compare the frequency of severe hypoglycemia leading to hospitalization (HH) and emergency visits (EV) for any cause in patients with type 2 diabetes mellitus exposed to dipeptidyl peptidase 4 (DPP4) inhibitors (DPP4-i) versus those exposed to insulin secretagogues (IS; sulfonylureas or glinides).MethodsData were extracted from the EGB (Echantillon Généraliste des Bénéficiaires) database, comprising a representative sample of ~1% of patients registered in the French National Health Insurance System (~600,000 patients). Type 2 diabetes mellitus patients exposed to regimens containing either a DPP4-i (excluding treatment with IS, insulin, or glucagon-like peptide 1 analog) or IS (excluding treatment with insulin and any incretin therapy) between 2009 and 2012 were selected. HH and EV during the exposure periods were identified in both cohorts. A similar analysis was conducted considering vildagliptin alone versus IS. Comparative analyses adjusting for covariates within the model (subjects matched for key characteristics) and using multinomial regression models were performed.ResultsOverall, 7,152 patients exposed to any DPP4-i and 1,440 patients exposed to vildagliptin were compared to 10,019 patients exposed to IS. Eight patients (0.11%) from the DPP4-i cohort and none from the vildagliptin cohort (0.0%) were hospitalized for hypoglycemia versus 130 patients (1.30%) from the IS cohort (138 hospitalizations) (P=0.02 and P<0.0001, respectively). Crude rates of HH/1,000 patient-years were 1.4 (95% CI: 0.7; 2.4) in the DPP4-i cohort, 0.0 in the vildagliptin cohort (95% CI: 0.0; 4.0), versus 5.6 (95% CI, 4.7; 6.6) in the IS cohort (P<0.0001). After adjustments, rates per 1,000 patient-years of HH were 1.4 (95% CI: 0.7; 2.4) with DPP4-i versus 7.5 (95% CI: 6.0; 9.2) with IS (P<0.0001), and 0.0 (95% CI: 0.0; 4.0) with vildagliptin versus 13.6 (95% CI: 10.4; 17.5) with IS (P<0.0001). Adjusted EV rates were also significantly lower with all DPP4-i or with vildagliptin, as compared to IS (P<0.0001). Consistent results were found when considering only treatment initiations for all compared cohorts.ConclusionHH and EV were significantly less frequent in patients exposed to any DPP4-i or to vildagliptin versus IS. These real-life data should be considered in the benefit/risk evaluation of the drugs.

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“…Endothelial dysfunction is further aggravated in people with DM because SARS-CoV2 infection induces endotheliitis in several organs as a direct consequence of viral involvement and of the host inflammatory response [ 54 ]. Hypoglycemia (blood glucose levels < 3.9 mmol/L) is the most frequent acute complication of DM and the main obstacle to achieving optimal glycemic control; it is associated mostly with the use of insulin and sulfonylureas [ 93 ]. In patients with T1DM, hypoglycemia is very common and unpredictable; it can be severe when associated with unawareness of the preliminary warning symptoms, predisposing patients to life-threatening complications [ 94 ].…”

Section: The Association Between Dm and Covid-19mentioning

confidence: 99%

Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns

Koliaki

Tentolouris

Eleftheriadou

et al. 2020

JCM

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The management of patients with diabetes mellitus (DM) in the era of the COVID-19 pandemic can be challenging. Even if they are not infected, they are at risk of dysregulated glycemic control due to the restrictive measures which compromise and disrupt healthcare delivery. In the case of infection, people with DM have an increased risk of developing severe complications. The major principles of optimal care for mild outpatient cases include a patient-tailored therapeutic approach, regular glucose monitoring and adherence to medical recommendations regarding lifestyle measures and drug treatment. For critically ill hospitalized patients, tight monitoring of glucose, fluids, electrolytes, pH and blood ketones is of paramount importance to optimize outcomes. All patients with DM do not have an equally increased risk for severity and mortality due to COVID-19. Certain clinical and biological characteristics determine high-risk phenotypes within the DM population and such prognostic markers need to be characterized in future studies. Further research is needed to examine which subgroups of DM patients are expected to benefit the most from specific antiviral, immunomodulatory and other treatment strategies in the context of patient-tailored precision medicine, which emerges as an urgent priority in the era of COVID-19.

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Hypoglycaemia requiring medical assistance in patients with diabetes: A prospective multicentre survey in tertiary hospitals

Cited by 14 publications

References 28 publications

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Hypoglycemia hospitalization frequency in patients with type 2 diabetes mellitus: a comparison of dipeptidyl peptidase 4 inhibitors and insulin secretagogues using the French health insurance database

Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns

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