This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (96)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Ronald I. Shorr, MD, MS; Wayne A. Ray, PhD; James R. Daugherty, MS; Marie R. Griffin, MD, MPH

Arch Intern Med. 1997;157(15):1681-1686.

Abstract
Background
Our knowledge about the risk of hypoglycemia associated with diabetes treatment is derived from studies that often exclude frail, elderly persons.

Objective
To determine the incidence and risk factors for developing serious hypoglycemia among older persons using sulfonylureas or insulin.

Methods
We conducted a population-based, retrospective cohort study of 19 932 Tennessee Medicaid enrollees, aged 65 years or older, who used insulin or sulfonylureas from 1985 through 1989. The main end point was serious hypoglycemia defined as a hospitalization, emergency department admission, or death associated with hypoglycemic symptoms and a concomitant blood glucose determination of less than 2.8 mmol/L (<50 mg/dL).

Results
We identified 586 persons with a first episode of serious hypoglycemia during 33 048 person-years of insulin or sulfonylurea use. The crude rates (per 100 person-years) of serious hypoglycemia were 1.23 (95% confidence interval [CI], 1.08-1.38) in users of sulfonylureas and 2.76 (95% CI, 2.47-3.06) among insulin users. Recent hospital discharge was the strongest predictor of subsequent hypoglycemia in older persons with diabetes. The adjusted relative risk of serious hypoglycemia occurring in days 1 through 30 after hospital discharge was 4.5 (95% CI, 3.5-5.7) compared with the risk associated with a hypoglycemic event occurring 366 or more days after hospital discharge. Other independent risk factors included advanced age (relative risk, 1.8; 95% CI, 1.4-2.3), black race (relative risk, 2.0; 95% CI, 1.7-2.4), and use of 5 or more concomitant medications (relative risk, 1.3; 95% CI, 1.1-1.5).

Conclusions
In this population, the incidence of serious hypoglycemia is approximately 2 per 100 person-years, suggesting that many older adults can be safely treated with hypoglycemic drugs. Frail, elderly persons— the oldest-old, those using multiple medications, and those who are frequently hospitalized—are at a higher risk for drug-associated hypoglycemia. Such individuals may benefit from intensive education about the symptoms of hypoglycemia and close monitoring for adverse events related to diabetes treatment.

Arch Intern Med. 1997;157:1681-1686

Author Affiliations
From the Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tenn. Dr Shorr is now with the Department of Preventive Medicine, University of Tennessee—Memphis College of Medicine, and the Department of Medical Education, Methodist Hospitals of Memphis.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

24-Hour observational ward management of diabetic patients presenting with hypoglycaemia: a prospective observational study
Goh et al.
Emerg. Med. J. 2009;26:719-723.
ABSTRACT | FULL TEXT  

The utility of routine laboratory testing in hypoglycaemic emergency department patients
Sinert et al.
Emerg. Med. J. 2009;26:28-31.
ABSTRACT | FULL TEXT  

Diabetes Care in Extended-Care Facilities: Appropriate intensity of care?
Holt et al.
Diabetes Care 2007;30:1454-1458.
ABSTRACT | FULL TEXT  

Diabetic and endocrine emergencies
Kearney and Dang
Postgrad. Med. J. 2007;83:79-86.
ABSTRACT | FULL TEXT  

Special Considerations in Older Adults With Diabetes: Meeting the Challenge
Sinclair
Diabetes Spectr. 2006;19:229-233.
ABSTRACT | FULL TEXT  

Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology, and Management
Briscoe and Davis
Clin. Diabetes 2006;24:115-121.
ABSTRACT | FULL TEXT  

Hypoglycemia in Type 2 Diabetes: Pathophysiology, frequency, and effects of different treatment modalities
Zammitt and Frier
Diabetes Care 2005;28:2948-2961.
FULL TEXT  

Toxicity of Oral Agents Used to Treat Diabetes
Lada and Idrees
Journal of Pharmacy Practice 2005;18:145-156.
ABSTRACT  

Hospital Management of Hyperglycemia
Campbell and Braithwaite
Clin. Diabetes 2004;22:81-88.
FULL TEXT  

Management of Diabetes and Hyperglycemia in Hospitals
Clement et al.
Diabetes Care 2004;27:553-591.
FULL TEXT  

Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients
Kagansky et al.
Arch Intern Med 2003;163:1825-1829.
ABSTRACT | FULL TEXT  

Diabetes-Related Morbidity and Mortality in a National Sample of U.S. Elders
Bertoni et al.
Diabetes Care 2002;25:471-475.
ABSTRACT | FULL TEXT  

Hypoglycemia: An Excuse for Poor Glycemic Control?
Saleh and Grunberger
Clin. Diabetes 2001;19:161-167.
ABSTRACT | FULL TEXT  

Clinical Management of Diabetes in the Elderly
Chau and Edelman
Clin. Diabetes 2001;19:172-175.
FULL TEXT  

Hypoglycemia in Patients With Type 2 Diabetes Mellitus
Miller et al.
Arch Intern Med 2001;161:1653-1659.
ABSTRACT | FULL TEXT  

Comorbidity and Glycemic Control in Patients With Type 2 Diabetes
El-Kebbi et al.
Arch Intern Med 2001;161:1295-1300.
ABSTRACT | FULL TEXT  

Management of Type 2 Diabetes in the Geriatric Patient
Campbell
Journal of Pharmacy Practice 2000;13:263-276.
ABSTRACT  

Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients: Results from the national cooperative cardiovascular project
Chen et al.
J Am Coll Cardiol 1999;34:1388-1394.
ABSTRACT | FULL TEXT  

Oral Glibenclamide Suppresses Glucagon Secretion during Insulin-Induced Hypoglycemia in Patients with Type 2 Diabetes
Landstedt-Hallin et al.
J. Clin. Endocrinol. Metab. 1999;84:3140-3145.
ABSTRACT | FULL TEXT  

Hypoglycemia From Glipizide and Glyburide
Shorr et al.
JAMA 1998;279:1441-1443.
FULL TEXT  

Risk of Hypoglycemia With Antihypertensive Medication-Reply
Shorr et al.
JAMA 1997;278:1570-1571.
ABSTRACT  

Sulfonylureas: Unsafe for Older Diabetics?
JWatch Women's Health 1997;1997:7-7.
FULL TEXT