Has the safety of diabetes therapy improved? Lessons from an analysis of diabetic medication-induced severe hypoglycemic cases in an emergency department from 2005 to 2013

Aims: We investigated the incidence and clinical characteristics of diabetic medication-induced severe hypoglycemia (DMISH) in an emergency department (ED) from 2005 to 2013. Methods: The observation was performed in two separate periods (1 July 2005–31 October 2006 and 1 July 2012–31 October 2013) in the ED of Asahikawa Red Cross Hospital. Results: The number of DMISH cases (48 during 2005–2006, and 47 during 2012–2013) and their proportions of all emergency visits (0.77 % during 2005–2006, and 0.79 % during 2012–2013) were almost identical for the two periods. Patients’ mean age (years) was 69.8 during 2005–2006 and 73.8 during 2012–13. Mean HbA1c of the patients was 6.72 % during 2012–2013 and 7.27 % during 2005–2006. Plasma glucose level at ED arrival was significantly higher and hospitalization rate of hypoglycemic patients was significantly lower during 2012–2013 than during 2005–2006. Mean sulfonylurea dose, converted to glimepiride, was 3.0 mg during 2005–2006 and 2.3 mg during 2012–2013. The number of patients living alone increased by 63 %, and those living with younger family members decreased by 50 % during 2012–2013 compared with that during 2005–2006. Conclusions: Although there has been progress in avoiding severe hypoglycemia from 2005 to 2013, the increased number of isolated older diabetic elderly seems to have counteracted clinicians’ efforts. A patient-centered approach that sets individualized glycemic targets and selects treatment that balances efficacy and safety is key to avoiding severe hypoglycemia. Improved social support for diabetic elderly patient is also important. © 2015, The Japan Diabetes Society.