Bouma, A.J. (2015) The prevalence of (symptomatic) hypoglycaemia in elderly patients with well-controlled type 2 diabetes mellitus: the results of continuous glucose monitoring. thesis, Medicine.
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Abstract
Introduction The current national primary care guideline recommends a sulfonylurea, explicitly gliclazide as the second step in diabetes management. One of the reasons is the substantially lower hypoglycaemia risk in gliclazide compared to other sulfonylurea derivatives (SUs). However, data regarding hypoglycaemia rates in elderly patients using SUs is very limited. Hypoglycaemic events can be easily reported using a continuous glucose monitoring system (CGMS). Previous studies with CGMS already showed that unrecognized hypoglycaemic events are easily missed in elderly patients. Data regarding the effects of SUs, specifically gliclazide, are needed for confirming the safety of gliclazide in frail elderly patients treated in primary care. The aim this pilot study is to investigate the prevalence of (symptomatic) hypoglycaemic events in frail elderly patients with type 2 diabetes treated with sulfonylurea and metformin. Material & methods An observational pilot in patients with type 2 diabetes, 70 years or older, with HbA1c <58 mmol/mol, a score on the Groningen Frailty Indicator (GFI) >4, treated with metformin monotherapy or metformin and gliclazide or glimepiride. These patients were evaluated with CGMS for 5 days. Patients performed self-measurement of blood glucose levels four times a day and also recorded symptoms of a hypoglycaemic event in their diary. The number of hypoglycaemic events with a glucose value less than 3.0 mmol/L and, additionally, the number of hypoglycaemic events with a glucose value less than 3.5 mmol/L were determined. An event was defined as a glucose value that persisted for at least 15 minutes with or without symptoms. Results 23 patients (47% male) with a mean age 76.3 ± 4.4 years, a mean diabetes duration 8.3 ± 3.6 years, mean HbA1c 48.7 ± 4.1 mmol/mol and a median GFI-score of 5 [4-6] were monitored for an average of 97h 15 min. All patients completed the study. Five out of 23 patients (22%) experienced a total of 15 events with a glucose value less than 3.0 mmol/L. Two patients using gliclazide experienced six of these events and three patients using glimepiride experienced nine events. Eight out of 23 patients (35%) experienced a total of 25 events with a glucose value less than 3.5 mmol/L. Two patients using metformin monotherapy experienced two events, two patients using gliclazide experienced seven events and four patients using glimepiride experienced sixteen events. No hypoglycemic event was recorded by any patient. Patients using glimepiride who experienced more than one event had lower HbA1c levels compared to the patients using gliclazide (p=0.031). Conclusions This study confirmed the presence of unrecognized hypoglycaemic events in patients treated with metformin monotherapy. Gliclazide seems to have a lower risk of asymptomatic hypoglycaemic events compared to glimepiride. However, in patients using glimepiride experiencing at least one event HbA1c was significant lower compared to patients using gliclazide. Based on our study the preference of gliclazide also seems to be justified in frail elderly patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Bilo, prof. Dr. H.J.G. and internist Diabetes Kenniscentrum, Isala klinieken and Hateren, dr. K.J.J. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2406 |
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