INT-010 Impact of drugs on hypoglycaemia in hospitalised patients

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Abstract

Background

Hypoglycaemia is a life threatening condition that can be encountered during hospitalisation. Several risk factors have been identified, such as critical illness or general anaesthesia. Drug induced hypoglycaemia is classically related to several antidiabetic drugs. However, a growing number of reports associating hypoglycaemia with non-antidiabetic drugs have been published recently. Clinical pharmacists are often faced with hypoglycaemia in patients with multiple medications.

Purpose

The aim of this study was to investigate the potential risk between prescribed drugs and hypoglycaemia episodes during hospitalisation.

Material and methods

Patients from a regional hospital admitted between 2013 and 2015 were analysed. Point of care blood glucose values and prescribed drugs were extracted from electronic records. Hypoglycaemia cases were defined as having at least one hypoglycaemic event (random glucose value ≤3.9 mmol/L), and normoglycaemic cases as those with random glucose concentrations within the range of 4.5–5.8 mmol/L during hospitalisation. Patients who did not meet these criteria were excluded from analysis. Statistical analysis was carried out using multivariate logistic regressions and Cox proportional hazard models.

Results

A total of 373 patients (53% men; median age 74 years) were included in the analysis and of these, 64 (17%) had at least one hypoglycaemic event. Patients who experienced a hypoglycaemic event had a longer duration of hospitalisation (median=10 vs 7 days, p<0.01) and a higher rate of antidiabetic drugs prescription (83% vs 37%, p<0.01). After adjusting for available confounders (age, gender, insulin and/or insulin secretagogues use), prescription of heparin (OR=2.8, 95% CI 1.7–7, p=0.02) and/or pantoprazole (OR=1.9, 95% CI 1–3.7, p=0.04) were associated with hypoglycaemia. Patients with more than eight administered non-diabetic drugs per day were at risk of hypoglycaemia during hospitalisation (hazard ratio=2.3, 95% CI 1.4–4, p<0.01).

Conclusions

Heparin and pantoprazole were found to be associated with hypoglycaemia events. These results require confirmation in further studies. The relationship between hypoglycaemia and polypharmacy supports the demand to limit polypharmacy as much as possible, especially in elderly patients. This result underlines the potential involvement of clinical pharmacists with the aim of reducing the risk of hypoglycaemia during hospitalisation.

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