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Cited by 221Diabetes Treatment and ManagementDiabetes Management and ResearchPharmaceutical Practices and Patient Outcomes

Individual Sulfonylureas and Serious Hypoglycemia in Older People

Shorr, Ronald I., Ray, Wayne A., Daugherty, James R., Griffin, Marie R.·1996·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.1996.tb03729.x
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Abstract

OBJECTIVE: To compare the risk of serious hypoglycemia associated with the use of individual sulfonylureas in older people. DESIGN: A retrospective cohort study SETTING: The Tennessee Medicaid Program PATIENTS: A total of 13,963 Medicaid enrollees, aged 65 years or older, who were prescribed one of six sulfonylureas from 1985 to 1989. MAIN OUTCOME MEASURE: Hospitalization, emergency room admission, or death associated with neuroglycopenic or autonomic symptoms, myocardial infarction, stroke, or injury, with a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL). RESULTS: We identified 255 persons with a first episode of serious hypoglycemia during 20,715 person‐years of sulfonylurea use. The crude rate (per 1000 person‐years) of serious hypoglycemia was highest in glyburide users, 16.6 (95% confidence interval [CI], 13.2 to 19.9) and lowest among users of tolbutamide, 3.5 (95% CI, 1.2 to 5.9). Users of tolbutamide, tolazamide, and glipizide had lower risks of serious hypoglycemia than users of chlorpropamide, whereas the risk of serious hypoglycemia among glyburide users did not differ from that of chlorpropamide users. Among second generation sulfonylureas, the adjusted relative risk of severe hypoglycemia among glyburide users, compared with glipizide users, was 1.9 (95% CI, 1.2 to 2.9). An increased risk of serious hypoglycemia associated with use of glyburide compared with glipizide occurred in all strata, including those defined by gender, race, nursing home residence, dose, and duration of use. CONCLUSIONS: Significant differences in risk of serious hypoglycemia were observed among users of individual agents. This may be explained by duration, timing, or potency of hypoglycemic action. These data confirm previous findings that chlorpropamide use is associated with high risk of hypoglycemia and indicate that among second generation sulfonylureas, glipizide is less associated with hypoglycemia than is glyburide. More information comparing the effectiveness of glycemic control among individual sulfonylureas is needed to assist prescribers in selecting a specific agent for use in clinical practice.

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Crossref · 10.1111/j.1532-5415.1996.tb03729.x

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  • Age-related changes may translate into increased risk for hypoglycemia, potential need for reduced doses of certain medications, and attention to renal function to minimize side effects.

    “These changes may translate into increased risk for hypoglycemia, potential need for reduced doses of certain medications, and attention to renal function to minimize side effects94, 95.”

    From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [95]

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Authors
Shorr, R. I., Ray, W. A., Daugherty, J. R., & Griffin, M. R.
Affiliations
  • University of Tennessee Health Science Center (US)
  • Vanderbilt University (US)
Corresponding author
Shorr, Ronald I.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
1996-07
Volume
44
Issue
7
Pages
751-755
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.1996.tb03729.x
OpenAlex
W1990421974
Cited by
221
References
33
Citations by year
2026: 3 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 7 · 2021: 12 · 2020: 6 · 2019: 6 · 2018: 12 · 2017: 10 · 2016: 8 · 2015: 14 · 2014: 12 · 2013: 5 · 2012: 5
FWCI
4.55
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 6874 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k08ag000559-06)
  • National Institute on Aging (K08-AG00559)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
older adults, glibenclamide, glipizide, chlorpropamide, tolbutamide, tolazamide, second-generation sulfonylureas, drug safety, diabetes mellitus, Medicaid enrollees, hospitalization, emergency department admission, mortality, nursing home residents, adverse drug reactions
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Retrospective Studies, Risk, Sulfonylurea Compounds, Tennessee, Cohort Studies

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