Secular Trends in the Clinical Characteristics of Type 2 Diabetic Patients With Severe Hypoglycemia Between 2008 and 2013

Overview

Journal J Clin Med Res

Specialty General Medicine

Date 2016 Sep 17

PMID 27635175

Authors

Hiroyuki Ito

Emiko Tsugami

Shigenori Ando

Ayano Imai

Suzuko Matsumoto

Takashi Omoto

Masahiro Shinozaki

Shinya Nishio

Mariko Abe

Shinichi Antoku

Mizuo Mifune

Michiko Togane

Affiliations

Soon will be listed here.

Abstract

Background: We investigated the trends in the clinical characteristics and prescriptions of type 2 diabetic patients with severe hypoglycemia because the prescription rate of antidiabetic agents has significantly changed recently.

Methods: A total of 193 patients with type 2 diabetes with severe hypoglycemia induced by antidiabetic agents between 2008 and 2013 were divided into three groups based on the period of visit: 2008 - 2009, 2010 - 2011 and 2012 - 2013.

Results: While the proportion of patients with severe hypoglycemia using insulin (from 55% to 74%), biguanides (from 6% to 20%), glinides, and dipeptidyl peptidase-4 inhibitors significantly increased, those using sulfonylureas (from 45% to 20%) significantly decreased. Errors of drug use significantly increased as a trigger of hypoglycemia in recent years. The number of antidiabetic agents (from 1.9 ± 0.6 to 2.3 ± 0.7), non-diabetic agents (from 2.3 ± 2.4 to 4.3 ± 3.3), and total drugs prescribed were significantly higher in recent years among patients receiving insulin therapy.

Conclusions: Polypharmacy especially in patients receiving insulin therapy and errors of drug use have increased in type 2 diabetic patients with severe hypoglycemia in recent years. Intensive education in the usage rule of drugs is considered to be important in order to prevent severe hypoglycemia.

References

Goto A, Arah O, Goto M, Terauchi Y, Noda M . Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013; 347:f4533. DOI: 10.1136/bmj.f4533. View

Oishi M, Yamazaki K, Okuguchi F, Sugimoto H, Kanatsuka A, Kashiwagi A . Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002-2011 in Japan (JDDM32). J Diabetes Investig. 2014; 5(5):581-7. PMC: 4188117. DOI: 10.1111/jdi.12183. View

Ahren B . Avoiding hypoglycemia: a key to success for glucose-lowering therapy in type 2 diabetes. Vasc Health Risk Manag. 2013; 9:155-63. PMC: 3639216. DOI: 10.2147/VHRM.S33934. View

von Mach M, Gauer M, Meyer S, Omogbehin B, Schinzel H, Kann P . Antidiabetic medications in overdose: a comparison of the inquiries made to a regional poisons unit regarding original sulfonylureas, biguanides and insulin. Int J Clin Pharmacol Ther. 2006; 44(2):51-6. DOI: 10.5414/cpp44051. View

Yale J . Oral antihyperglycemic agents and renal disease: new agents, new concepts. J Am Soc Nephrol. 2005; 16 Suppl 1:S7-10. DOI: 10.1681/asn.2004110974. View

Asplund K, Wiholm B, Lithner F . Glibenclamide-associated hypoglycaemia: a report on 57 cases. Diabetologia. 1983; 24(6):412-7. DOI: 10.1007/BF00257338. View

Seaquist E, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L . Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013; 36(5):1384-95. PMC: 3631867. DOI: 10.2337/dc12-2480. View

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven P . Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2008; 360(2):129-39. DOI: 10.1056/NEJMoa0808431. View

Gerstein H, Miller M, Byington R, Goff Jr D, Thomas Bigger J, Buse J . Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358(24):2545-59. PMC: 4551392. DOI: 10.1056/NEJMoa0802743. View

10.

Hemmingsen B, Lund S, Gluud C, Vaag A, Almdal T, Hemmingsen C . Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ. 2011; 343:d6898. PMC: 3223424. DOI: 10.1136/bmj.d6898. View

11.

Whitmer R, Karter A, Yaffe K, Quesenberry Jr C, Selby J . Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009; 301(15):1565-72. PMC: 2782622. DOI: 10.1001/jama.2009.460. View

12.

Abe M, Okada K, Soma M . Antidiabetic agents in patients with chronic kidney disease and end-stage renal disease on dialysis: metabolism and clinical practice. Curr Drug Metab. 2011; 12(1):57-69. DOI: 10.2174/138920011794520053. View

13.

Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M . Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358(24):2560-72. DOI: 10.1056/NEJMoa0802987. View

14.

Haneda M, Morikawa A . Which hypoglycaemic agents to use in type 2 diabetic subjects with CKD and how?. Nephrol Dial Transplant. 2008; 24(2):338-41. DOI: 10.1093/ndt/gfn616. View

15.

Nishio S, Abe M, Ito H . Anagliptin in the treatment of type 2 diabetes: safety, efficacy, and patient acceptability. Diabetes Metab Syndr Obes. 2015; 8:163-71. PMC: 4370682. DOI: 10.2147/DMSO.S54679. View

16.

Kohro T, Yamazaki T, Sato H, Harada K, Ohe K, Komuro I . Trends in antidiabetic prescription patterns in Japan from 2005 to 2011. Int Heart J. 2013; 54(2):93-7. DOI: 10.1536/ihj.54.93. View

17.

Lipska K, Warton E, Huang E, Moffet H, Inzucchi S, Krumholz H . HbA1c and risk of severe hypoglycemia in type 2 diabetes: the Diabetes and Aging Study. Diabetes Care. 2013; 36(11):3535-42. PMC: 3816866. DOI: 10.2337/dc13-0610. View

18.

Sako A, Yasunaga H, Matsui H, Fushimi K, Hamasaki H, Katsuyama H . Hospitalization for Hypoglycemia in Japanese Diabetic Patients: A Retrospective Study Using a National Inpatient Database, 2008-2012. Medicine (Baltimore). 2015; 94(25):e1029. PMC: 4504598. DOI: 10.1097/MD.0000000000001029. View

19.

Cryer P, Davis S, Shamoon H . Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6):1902-12. DOI: 10.2337/diacare.26.6.1902. View

20.

Ito H, Abe M, Shinozaki M, Oshikiri K, Yamashita H, Nakashima M . Hypoglycemia observed during continuous glucose monitoring in patients with type 2 diabetes mellitus treated by subcutaneous insulin injection. Diabetes Technol Ther. 2013; 15(7):586-90. DOI: 10.1089/dia.2013.0034. View