Endocrine Abstracts

Introduction: Hypoglycaemia remains the major barrier to tight glycaemic control in diabetes. Oral hypoglycaemic agents such as sulphonylureas (SU) remain one of the main options for managing type 2 diabetes mellitus (T2DM), but the glucose independent action is associated with an increased risk of hypoglycaemia. We present a retrospective audit of patients attending the A&E Department with severe hypoglycaemia at a large acute trust serving a population of 450 000.

Results: Data was collated using local A&E, electronic patient and GP records. Patients coded as having hypoglycaemia requiring hospital attendance were included. Between August 2008 and February 2012,434 patients attended A&E with a diagnosis of severe hypoglycaemia (229, 53% males). 212 (49%) were admitted and 33 (7.6%) died. The average (range) age was 63.5 (17–99) years, 321 (74%) had T2DM, 113 (26%) had T1DM, one had gestational DM. 109 patients with T2DM (34%) were managed with OHAs alone. Diabetes medication was known in 103. Of these 92 (89.3)% were on a SU (gliclazide; 60.2%, glimepiride; 27.2%, glibencamide; 1.9%). 34 (33%) were taking a SU alone, 51 (49.5%) in combination with metformin. 5 (4.8%) were on metformin alone, 24 (23.3%) were on additional OHAs in combination. 71 (68.9%) of patients on OHAs were admitted to hospital. Compared to those on insulin, patients on OHAs were older 75.9 vs 60.0 years, (P<0.0001) with a lower HbA1c of 6.8% vs 8.2%, (P<0.0001) and were more likely to be admitted (67 vs 44%). 44 (43%) on a SU had an HbA1c ≤48 mmol/mol and the mean age was 77.6 yearrs.

Discussion: This audit highlights the increased risk of hypoglycaemia associated with SU therapy. Patients on OHAs were older with a lower HbA1c compared to those on insulin. In particular 43% of patients on SU therapy had an HbA1c ≤48 mmol/mol. Although OHA’s are considered lower risk for hypoglycaemia, using national targets has resulted in this group of patients being more aggressively managed, putting them at increased risk. We recommend older patients should be given an individualised target for glycaemic control.