Risk of severe hypoglycemia in sulfonylurea-treated patients from diabetes centers in Germany/Austria: how big is the problem? which patients are at risk?

BACKGROUND We investigated the rate of severe hypoglycemic events and confounding factors in patients with type-2-diabetes treated with sulfonylurea (SU) at specialized diabetes centers, documented in the German/Austrian DPV-Wiss-database. METHODS Data from 29,485 SU-treated patients were analyzed (median[IQR] age 70.8[62.2-77.8]yrs, diabetes-duration 8.2[4.3-12.8]yrs). The primary objective was to estimate the event-rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency.hospitalization). Secondary objectives included exploration of confounding risk-factors through group-comparison and Poisson-regression. RESULTS Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of SU-treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event-rate of severe hypoglycemia [95%CI] was 3.9[3.7-4.2] events/100 patient-years (coma: 1.9[1.8-2.1]; hospitalization: 1.6[1.5-1.8]). Adjusted event-rates by diabetes-treatment were 6.7 (SU + insulin), 4.9 (SU + insulin + other OAD), 3.1 (SU + other OAD), and 3.8 (SU only). Patients with ≥1 severe event were older (p < 0.001) and had longer diabetes-duration (p = 0.020) than patients without severe events. Participation in educational diabetes-programs and indirect measures of insulin-resistance (increased BMI, plasma-triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common (N = 3,113 eGFR ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30-60 mL/min: 4.8; >60 mL/min: 3.9). CONCLUSIONS These real-life data showed a rate of severe hypoglycemia of 3.9/100 patient-years in SU-treated patients from specialized diabetes centers. Higher risk was associated with known risk-factors including lack of diabetes-education, older age, and decreased eGFR, but also with lower BMI and lower triglyceride-levels, suggesting that SU-treatment in those patients should be considered with caution. This article is protected by copyright. All rights reserved.

Der stille Garten

W. Blankenburg

Geh. Oberregierungsrat Dr. Mayer, Karlsruhe [Illustration] : Mitglied des Ausschusses der Gesellschaft zur Förderung der Wissenschaft des Judentums

Scan von Monochrom-Mikroform

Im Garten [Illustration] : (Ölbild)

Minna Lewi

Einladung zu der am Sonntag, den 24. August 1930 in Würzburg im Platz'schen Garten stattfindenden 49. Mitgliederversammlung und zu der damit verbundenen 50jährigen Jubiläumsfeier des jüdischen Lehrervereins für Bayern

M. Adler

Job Matching and Wage Growth in the U.S. and Germany

This paper examines the contribution of job matching to wage growth in the U.S. and Germany using data drawn from the Panel Study of Income Dynamics and the German Socio-Economic Panel from 1984 through 1992. Using a symmetrical set of variables and data handling procedures, real wage growth is found to be higher in the U.S. than in Germany during this period. Also, using two different estimators, job matches are found to enhance wage growth in the U.S. and retard it in Germany. The relationship of general skills to employment in each country appears responsible for this result.