Drug-induced hypoglycemic coma in 102 diabetic patients

Background: Hypoglycemic coma is a continuous threat for diabetic patients treated with insulin and/or oral hypoglycemic agents; it may be associated with substantial morbidity and mortality. Methods: We retrospectively reviewed our clinical experience with drug-indu ced hypoglycemic coma during a 7-year period. Results: The study consisted of 102 patients and included 61 females and 41 males. The median age was 72 years. Ninety-two patients suffered from type 2 diabetes mellitus; 10 patients had type 1 diabetes mellitus. The median lowest blood glucose level was 1.77 mmol/L (32 mg/dL). Drug-induced hypogly cemic coma occurred in 99 patients out of the hospital, while 3 patients de veloped it during hospitalization. Drug-induced hypoglycemic coma occurred in patients undergoing treatment with insulin, glyburide, and combined ther apy with insulin and glyburide, insulin and metformin, or glyburide and met formin. Ninety-three patients had at least 1 of the following risk factors: age older than 60 years, renal dysfunction, decreased intake of energy, an d infection. Fourteen patients concomitantly received drugs that potentiate d hypoglycemia. Forty patients responded to treatment within the first 12 h ours, while 62 patients had protracted hypoglycemia of 12 to 72 hours' dura tion. Morbidity included physical injuries in 7 patients, myocardial ischem ia in 2 patients, and stroke in 1 patient. Death occurred in 5 patients. Conclusions: Hypoglycemic coma is a serious and not an uncommon problem amo ng elderly patients with diabetes mellitus and treated with insulin and/or oral hypoglycemic drugs. Risk factors contribute substantially to the morbi dity and mortality of patients with drug-induced hypoglycemic coma. Enhance d therapeutic monitoring may be warranted when hypoglycemic drugs are admin istered to an elderly patient with the above predisposing factors and poten tiating drugs for hypoglycemia.