In a retrospective cohort study, U.S. nursing home residents had higher rates of hypoglycemic events following the initiation of glimepiride and with standard doses of sulfonylureas (SUs). Cardiovascular events were similar across SUs and doses. “Based on our results and available guidance on managing [type 2 diabetes] in older NH residents, when initiating an SU, reduced-dose glipizide (≤2.5 mg daily) may be the safest treatment to avoid severe hypoglycemia,” the authors conclude.
Medicare claims data were linked with Minimum Data Set 2.0 assessments for long-stay NH residents aged 65 years or older between Jan. 2008 and Sept. 2010. One-year outcomes of hospitalizations or emergency department visits for severe hypoglycemia, heart failure (HF), stroke, and acute myocardial infarction (AMI) were evaluated based on the SU medication initiated (glimepiride, glipizide, or glyburide) and doses (standard or reduced).
“The cohort (N = 6,821) included 3,698 new glipizide, 1,754 glimepiride, and 1,369 glyburide users,” report the investigators. “Overall, the mean (standard deviation) age was 81.4 (8.2) years, 4,816 (70.6%) were female, and 5,164 (75.7%) were White non-Hispanic residents. The rates of severe hypoglycemia were 30.3 (95% CI 22.3–40.1), 49.0 (95% CI 34.5–67.5), and 35.9 (95% CI 22.2–54.9) events per 1,000 person-years among new glipizide, glimepiride, and glyburide users, respectively (glimepiride versus glipizide HR 1.6, 95% CI 1.0–2.4, p = 0.04; glyburide versus glipizide HR 1.2, 95% CI 0.7–1.9, p = 0.59). The rates of severe hypoglycemia were 27.1 (95% CI 18.6–38.0) and 42.8 (95% CI 33.6–53.8) events per 1,000 person-years among new users of reduced and standard SU doses, respectively (HR 2.2, 95% CI 1.4–3.5, p < 0.01). Rates of HF, stroke, and AMI were similar between medications and doses.”