Risk of hypoglycemia in hospitalized patients prescribed a sulfonylurea.

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Risk of hypoglycemia in hospitalized patients prescribed a
sulfonylurea.

Christina M. Hedrick, Pharm.D.1, Amy C. Donihi, Pharm.D., BCPS2,
Kim Coley, Pharm.D.2; (1)University of Pittsburgh Medical Center
Presbyterian, Pittsburgh, PA; (2)University of Pittsburgh School of
Pharmacy, Pittsburgh, PA

Purpose: To identify the incidence of and risk factors associated with
hypoglycemia in hospitalized patients taking sulfonylureas.

Methods: A nested case-control study of adult patients who received a
sulfonylurea while hospitalized at a tertiary care hospital between
November 1, 2008 and October 31, 2009 was performed. Case
patients included those who experienced hypoglycemia (BG <70
mg/dL) during sulfonylurea treatment. Control patients included those
who never experienced hypoglycemia. Controls were matched 1:1
with cases based on gender and number of days treated with a
sulfonylurea. Potential risk factors for the development of hypoglycemia,
including patient age, renal insufficiency, NPO status, concomitant use
of insulin and beta blockers, and hospital location were compared.
Covariates with p values ≤0.1 in univariate regressions were included
in a multivariate logistic regression model.

Results: Overall 16% of patients who received a sulfonylurea
experienced ≥1 episode of hypoglycemia. Cases (n=117) were more
likely than controls (n=117) to be ≥65 (74% vs 53%, p<0.001), have
renal insufficiency (18% vs. 7%, p=0.013), and receive basal insulin
(28% vs. 14.5%, p=0.012), and less likely to receive glipizide (44% vs
57%, p=0.05). Variables included in the multivariate regression were
age ≥65, renal insufficiency, and treatment with glipizide, glyburide,
or basal insulin. Age ≥65 (OR = 3.07, p<0.001), basal insulin (OR =
3.01, p=0.002), and renal insufficiency (OR = 3.64, p=0.006) were
predictors of hypoglycemia and use of glipizide (OR = 0.44, p=0.005)
was found to be protective in the multivariate logistic regression model.

Conclusions: These results can be used to identify hospitalized
patients for whom sulfonylurea agents should be avoided due to
their high risk for sulfonylurea-related hypoglycemia.

Presented at 29th Annual Eastern States Conference for Pharmacy
Residents and Preceptors, Hershey, PA, April 2010.