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Colegio de Medicina Interna de México.

2017, Number 6

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Med Int Mex 2017; 33 (6)

Severe hypoglycemia in patients with diabetes mellitus type 2 and normal creatinine serum values

Casanova-Cardiel LJ, Montero-Benavides MO, Yarza-Fernández J, Legarreta-Holguín J, Flores-Rosillo MA

Language: Spanish
References: 23
Page: 739-745
PDF size: 504.31 Kb.


ABSTRACT

Background: Severe hypoglycemia is a frequent cause of hospitalization in Mexico.
Objective: To identify the clinical and laboratory characteristics associated to severe hypoglycemia in consecutive patients with severe hypoglycemia and normal creatinine serum values.
Patients and Method: A prospective study was done from August 11, 2011 to May 31, 2013, including patients with severe hypoglycemia and normal creatinine serum values. Age, sex, time of evolution of diabetes mellitus 2, antidiabetic treatment, comorbidities and 24-hour urine creatinine clearance were recorded.
Results: From 234 patients with severe hypoglycemia admitted, 21 (9%) had normal creatinine: 13 women (62%) and 8 (38%) men, with a mean age of 64.76 years (range: 42-84); 13 (62%) were older than 60 years; 15 (71%) had more than 5 years with DM2 (mean evolution of 9.2 years); 15 received glibenclamide (71%), 4 in combination with insulin (19%) and 8 with metformin (38%). Two received rosiglitazone plus insulin. Four patients had not comorbidities (19%); 16 had arterial hypertension (71%) and 3, neoplasms (adenocarcinoma, gastric carcinoma and esophageal carcinoma). Eleven patients (52%) were admitted with syncope, 5 with disorientation (24%), 4 with conduct disorders (19%) and one with dyslalia (5%); 15 of 21 patients (71%) had advanced degrees of renal impairment, despite normal creatinine serum values.
Conclusions: It is important to perform creatinine clearance at all levels of care, the only guide for safe treatments according to kidney function. Glibenclamide should be cautiously prescribed in older adults with a history of more than 10 years of diabetes mellitus 2 and should be avoided in those with documented chronic renal failure.


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