Dangerous antidiabetic overtreatment of patients with Typ 2 diabetes having experienced severe hypoglycaemia

Résumé fourni par la source

Aims: Severe hypoglycaemia (SH) may increase cardiovascular and all-cause mortality in patients with long-standing complicated diabetes. We investigated whether in patients with T2DM who had experienced SH individual morbidity and treatment targets had sufficiently been respected. Methods: Prospective population-based observational trial capturing all episodes of SH between 2007 and 2014 in the Lippe-Detmold area. SH was defined as a symptomatic event requiring treatment with intravenous glucose or glucagon administration and being confirmed by a blood glucose measurement of < 50 mg/dl. Results: 51.9% (n = 561) of all 1,080 episodes of SH were related to T2DM (initial blood glucose 33.9 ± 11.2 mg/dl). Hypoglycaemic patients with T2DM and SH have most frequently been treated with insulin (CT 34.2%, ICT 32.5%) and sulphonylureas (SU) (SU mono 24.2%, SU+insulin 7.2%) and patients were characterized as follows: age 77.3 ± 10.2 years, diabetes duration 15.2 ± 8.7 years, HbA1c 6.6 ± 1.4% (reference 6.0%), creatinine clearance < 60 ml/min 59.3% and < 30 ml/min 22.6%. 29.0% of patients suffered from dementia and 18.5% from cancer. The Charlson comorbidity index was 8.8 ± 2.7 (mean of 5.1 ± 2 severe comorbidities). 36% of patients were living in institutional homes or were cared by home nursing services. Conclusions: The majority of individuals with T2DM and SH showed a geriatric multimorbidity indicating short life expectancy and was clearly overtreated with antidiabetic drugs or insulin. Severe comorbidities as well as contraindications to SUs were disregarded resulting in a high risk for SH. In patients with T2DM, SH could effectively be prevented if individual morbidity and therapeutic targets would adequately be respected.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.