UTILIZATION OF ANTIDIABETIC DRUGS IN HONG-KONG - RELATION TO THE COMMON OCCURRENCE OF ANTIDIABETIC DRUG-INDUCED HYPOGLYCEMIA AMONGST ACUTE MEDICAL ADMISSIONS AND THE RELATIVE PREVALENCE OF NIDDM

Antidiabetic drug-induced hypoglycemia as a cause of acute medical adm issions is more common in Hong Kong (1.7%) than in other countries (0. 1 - 0.5%). To determine if this higher incidence may be related to the frequent use of some sulphonylureas, we have studied the overall pres cribing patterns in the public sector in 1994 by reviewing the utiliza tion of antidiabetic drugs in the general out-patient/general practice clinics (GOPD) and Hospital Authority public hospitals and affiliated specialist clinics (HA). The vast majority of patients (90.5%) receiv ing antidiabetic treat ment were taking sulphonylureas and/or metformi n, confirming that diabetes mellitus in Hong Kong is predominantly of the noninsulin-dependent type. The GOPD and the HA each accounted for approximately half of the sulphonylureas (55% vs 45%) and metformin (4 3% vs 57%) prescribed. Glibenclamide (84.9% vs 79.1%, 83.7% overall) a nd gliclazide (12.8% vs 16.6%, 14.5% overall) were the 2 most frequent ly used sulphonylureas. Only 9.5% of patients on antidiabetic drugs we re receiving insulin and 92% of this was prescribed by the HA. For com parison, Singapore has a similar prevalence of diabetes mellitus but a much lower incidence of antidiabetic drug-induced hypoglycemia amongs t acute medical admissions (0.5%). Tolbutamide was the most frequently used there sulphonylurea (66.6 - 72.2%) with glibenclamide only contr ibuting 20.8 - 28.6%. Thus, the predominant use of glibenclamide in Ho ng Kong may contribute to the high incidence of antidiabetic drug-indu ced hypoglycemia amongst acute medical admissions.