The Clinical Course of Patients with Type 2 Diabetes Presenting to the Hospital with Sulfonylurea-Induced Hypoglycemia

Background: This study describes the clinical course of adult patients with type 2 diabetes taking a sulfonylurea and presenting to the hospital with severe hypoglycemia. Subjects and Methods: This was a retrospective chart review of all patients >15 years of age with type 2 diabetes and taking a sulfonylurea who presented to the emergency services of Auckland City Hospital over a 6-year period with severe hypoglycemia. Results: One hundred eighty-five patients met the inclusion criteria. Their mean +/- SD age was 71 +/- 11 years, and known duration of diabetes was 14.7 +/- 10 years. Of the patients, 167 had micro- and/or macrovascular complications of diabetes, and one-third had had a previous admission with hypoglycemia. Only 61 patients (33%) had a glomerular filtration rate of >60 mL/min. The length of stay was not correlated with admission creatinine level (highest tertile of creatinine, 71 +/- 93 h; lowest tertile, 51 +/- 79 h). Recurrent in-hospital hypoglycemia occurred in over one-third of patients, and 28 (15%) were re-admitted to the hospital within 28 days of discharge for various reasons, including further hypoglycemia in 13 patients. Two patients died during their admission. Conclusions: Patients with type 2 diabetes presenting to the hospital with sulfonylurea-associated hypoglycemia have a high burden of comorbidity, require a long hospital stay, and are at risk of subsequent re-admission to hospital. Careful evaluation of their best future treatment strategies must be undertaken taking account of their comorbidities, including their renal function.