Meryl Hodge1, Eric McArthur2, Amit X Garg3, Navdeep Tangri4, Kristin K Clemens5. 1. School of Health Studies, Western University, London, Ontario, Canada. 2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 4. Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Seven Oaks General Hospital, Winnipeg, Manitoba, Canada. 5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ontario, Canada. Electronic address: kristin.clemens@sjhc.london.on.ca.
Abstract
BACKGROUND: Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013. FACTORS: eGFR stage, ACR stage, and use of antihyperglycemic medications. OUTCOME: 3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter). RESULTS: In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2 or the patient was receiving dialysis, respectively (P<0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P<0.001). A similar relationship was evident by eGFR and ACR risk category. LIMITATIONS: Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients. CONCLUSIONS: In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.
BACKGROUND: Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013. FACTORS: eGFR stage, ACR stage, and use of antihyperglycemic medications. OUTCOME: 3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter). RESULTS: In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2 or the patient was receiving dialysis, respectively (P<0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P<0.001). A similar relationship was evident by eGFR and ACR risk category. LIMITATIONS: Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients. CONCLUSIONS: In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.
Authors: Alexandra K Lee; Clare J Lee; Elbert S Huang; A Richey Sharrett; Josef Coresh; Elizabeth Selvin Journal: Diabetes Care Date: 2017-09-19 Impact factor: 19.112
Authors: Mohammed S Abusamaan; Mark A Marzinke; Aditya Ashok; Karen Carroll; Kyrstin Lane; Rebecca Jeun; Kendall F Moseley; Kathryn A Carson; Nestoras N Mathioudakis Journal: Medicine (Baltimore) Date: 2020-01 Impact factor: 1.817