Endocrine Abstracts

Background: Hypoglycemia is a common complication of Diabetes Mellitus treatment, especially in patients receiving intensive therapy. It can cause severe clinical consequences and is an obstacle to achieve glycemic targets.

Methods: Retrospective study of severe hypoglycemia due to insulin or oral drug therapy that lead to hospitalization in a central hospital. We reviewed the medical records in the last 7 years (2006–2012) for blood glucose levels at admission and pre-hospital care, A1c, diabetes duration, current therapy and comorbidities. There were 242 inpatient hospitalizations of 228 patients. We compared the hypoglycemic rate and the most commonly prescribed class of oral agents and insulin.

Results: The mean age of our patients was 76 (53–93) years, duration of hospitalization was 11 (1–123) days and 3 died in the hospital. In those with hypoglycemia as the main diagnostic (n=132), 5.7% had diabetes mellitus type 1 and 94.3% type 2. Of all subjects (n=242) 34.5% used insulin and 59.5% oral drugs (78% of them were treated with a sulfonylurea), the remaining 6% were not specified therapy. The mean blood glucose level was 36 mg/dl at pre-hospital care (7–60), at hospital admission 84 mg/dl (7–211) and mean HbA1c was 6.9% (5–13% and 49% had HbA1c below 7%). Most patients had impaired renal function (mean creatininemia 1.6 mg/dl (0.5–6.4)) and macrovascular disease. The hospital admissions rose from 2006 to 2010, and then decreased (assuming 24 admissions in 2006=100%: 2007=121%, 2008=179%, 2009=175%, 2010=175%, 2011=129%, 2012=100%).

Discussion and conclusion: The overall admissions due to severe hypoglycemia occurred in older patients. Also frequent was renal function impairement, HbA1c<7% and treated with insulin or a sulfonylurea. In this decade, overall incidence of admissions due to hypoglycemia in diabetic patients is falling, which match with the change of prescription pattern of oral agents (less sulfonylureas prescribed and the increased use of DPP4 inhibitors).