Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Rajendran, Rajesh; Hodgkinson, D W; Rayman, Gerry

doi:10.1136/postgradmedj-2014-132926

Cited by 15 publications

(23 citation statements)

References 17 publications

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“…In older patients with type 2 diabetes, achieving glycaemic control is very problematic, with adverse effects such as hypoglycaemia reported to be common in such patients . The consequences of hypoglycaemia impact substantially on patients and the healthcare system: these include physical injury, psychological harm, impaired cognition, reduced quality of life, mortality, additional manpower and resource utilization, and the costs of providing emergency assistance . The majority of older type 2 diabetes patients have coexisting frailty and comorbidities such as renal and cognitive impairment, and the risk of hypoglycaemia is particularly high in these patients .…”

Section: Introductionmentioning

confidence: 99%

“…7,8 The consequences of hypoglycaemia impact substantially on patients and the healthcare system: these include physical injury, psychological harm, impaired cognition, reduced quality of life, mortality, additional manpower and resource utilization, and the costs of providing emergency assistance. [9][10][11][12][13][14] The majority of older type 2 diabetes patients have coexisting frailty and comorbidities such as renal and cognitive impairment, and the risk of hypoglycaemia is particularly high in these patients. 7,9,15 Despite recommendations by guideline bodies to individualize glycaemic targets with risk assessments aimed at avoiding overtreatment and hypogycaemia, [16][17][18] recent data suggest increased hospital emergencies for hypoglycaemia.…”

Section: Introductionmentioning

confidence: 99%

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Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

Seidu

Kunutsor

Topsever

et al. 2019

Diabetes Obesity Metabolism

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Aim To assess deintensification approaches and rates and evaluate the harm and benefits of deintensification with antidiabetic medication and other therapies among older people (≥ 65 years) with type 2 diabetes with or without cardiometabolic conditions. Methods We identified relevant studies in a literature search of MEDLINE, Embase, Web of Science and Cochrane databases to 30 October 2018. Data were extracted on baseline characteristics, details on deintensification and outcomes, and was synthesized using a narrative approach. Results Ten studies (observational cohorts and interventional studies) with data on 26 558 patients with comorbidities were eligible. Deintensification approaches included complete withdrawal, discontinuation, reducing dosage, conversion, or substitution of at least one medication, but the majority of studies were based on complete withdrawal or discontinuation of antihyperglycaemic medication. Rates of deintensification approaches ranged from 13.4%–75%. The majority of studies reported no deterioration in HbA1c levels, hypoglycaemic episodes, falls or hospitalizations on deintensification. On adverse events and mortality, no significant differences were observed among the comparison groups in the majority of studies. Conclusion Available but limited evidence suggests that the benefits of deintensification outweigh the harm in older people with type 2 diabetes with or without comorbidities. Given the heterogeneity of patients with diabetes, further research is warranted on which deintensification approaches are appropriate and beneficial for each specific patient population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

Seidu

Kunutsor

Topsever

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Although recent data suggest a reversal in this trend, emergency admissions for hypoglycaemia remain significantly higher than a decade ago [2]. Older people are particularly vulnerable, with advanced age, diabetes duration, polypharmacy [3] and comorbidity, such as renal [4] or cognitive impairment [5] and frailty [6] being predisposing risk factors. The consequences can be serious, with physical injury including fractures, head injury or cardiovascular events [4] or psychological harm affecting quality of life [7], and with increased mortality, both in the short and longer term [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies

et al. 2017

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“…In a recent audit, patients taking a sulphonylurea accounted for 33% of admissions for hypoglycaemia to an Accident and Emergency department among people with type 2 diabetes. 7 The frail elderly were at particularly high risk, for whom 1-year all-cause mortality was an alarming 28%.…”

Section: Direct Insulin Secretagoguesmentioning

confidence: 99%

The new NICE guidelines for type 2 diabetes – a critical analysis

et al. 2015

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The latest NICE guidelines for the management of type 2 diabetes are now available for consultation. They contain sensible recommendations regarding lifestyle, patient education, monitoring and targets.Unfortunately, the pharmacotherapy section shows a distinct failure of common sense. The recommendations include using the insulin secretagogue repaglinide as a firstline agent, where metformin is not tolerated or contraindicated, or second-line in combination with metformin. Pioglitazone is recommended as the principal second-line therapy with metformin. The advice on glucagon-like peptide-1 receptor agonist (GLP-1ra) usage and assessment of efficacy and failure to recommend long acting analogue insulins over isophane are also major concerns.The recommendations appear to be based on metaanalyses and pharmacoeconomics, driven by an imperative on costs and failing to appreciate the "value" of the options under consideration. The cost to patients and the health service of the serious side-effects of these treatments is underestimated.Given the emphasis in these guidelines on the importance of lifestyle changes, including weight loss, plus an over-riding need to avoid hypoglycaemia, these pharmacotherapeutic recommendations appear paradoxical in the extreme.We believe that these recommendations, if enacted, will undermine seriously the reputation of NICE both nationally and internationally. Br J Diabetes Vasc Dis 2015;15:3-7

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Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Abstract: Dependence on a single data source would have at best identified only 65% of episodes. One-third of episodes were sulfonylurea related in patients with type 2 diabetes, and one-fourth of all patients with diabetes who required ED care for hypoglycaemia died the following year.

Cited by 15 publications

References 17 publications

Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies

The new NICE guidelines for type 2 diabetes – a critical analysis

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