Acil Serviste Antidiyabetik İlaçlara Bağlı Hipogliseminin Değerlendirilmesi

Year 2020, Volume: 3 Issue: 1, 6 - 8, 30.03.2020

Serdar Özdemir , Abdullah Algın , Hatice Şeyma Akça Serkan Emre Eroğlu

Abstract

Amaç
Artan diyabetes mellistus prevelansı acil servise olan diyabet ilişkili başvuruları da arttırmaktadır. Biz çalışmamızda kliniğimize başvuran antidiyabetik ilaç kullanan hastalarda görülen hipoglisemi olgularının demografik verilerini, kullandıkları antidiyabetik ilaçları ve klinik takip süreçlerini değerlendirmeyi amaçladık.

Gereç ve Yöntemler
SBÜ Ümraniye EAH Acil Tıp Kliniğine 01.10.2018 ve 01.10.2019 tarihleri arasında başvuran hastaların hastane bilgisayar tabanlı veri sisteminden kan glikoz düzeyi 50 mg/dL altında olan hastalar retrospektif olarak tarandı. Düşük kan glikoz düzeyi ile başvuran hastaların dosyaları incelendi.

Bulgular
Hastane bilgisayar tabanlı veri sisteminden yararlanarak kan glikoz düzeyi 50 mg/dL altında olan 153 hasta tespit edildi. Bu hastaların 75’inin antidiyabetik ilaçlara bağlı hipoglisemik olduğu tespit edildi. Hastalar aldıkları antidiyabetik ilaçlara göre değerlendirildiğinde 47 (%62,6) hastanın insülin, 11 (%14,6) hastanın insülin ile beraberinde OAİ ve 17 (%22) hastanın ise sadece OAİ kullandığı görüldü. Acil serviste takip edilip taburcu edilen hastaların takip süreleri ise 2 saat ile 24 saat arasında değişmekteydi. Bu hasta grubunda ortalama takip süresi 9,4 saatti. Yatırılarak takip edilen hastaların birinin (%1,3) yatışı sırasında gelişen pnömoniye bağlı mortalite ile sonuçlandığı görüldü.

Sonuç
Hipoglisemi yaşamı tehdit eden, bir antidiyabetik ilaç toksisitesidir. Bu ilaçları kullanan hastalar hipoglisemi semptomları açısından bilgilendirilmelidir.

Keywords

diyabetes mellistus, hipoglisemi, insülin, oral antidiyabetik ilaç

Evaluation of Hypoglycaemia Associated with Antidiabetic Drugs in the Emergency Department

Abstract

Aim
The increased prevalence of diabetes mellistus also increases the number of diabetes-related admissions to the emergency department. In this study, we aimed to evaluate the demographic data, antidiabetic drugs and clinical follow-up of hypoglycemia patients who were taking antidiabetic medications.

Material and Methods
Patients who applied to SBU Ümraniye EAH Emergency Medicine Clinic between 01.10.2018 and 01.10.2019 with blood glucose levels below 50 mg/dL were evaluated retrospectively from hospital computer-based data system. Patients who developed hypoglycemia due to hypoglycemic drug use were included in the study.

Results
Using the hospital computer-based data system, 153 patients with blood glucose levels below 50 mg/dL were identified. Seventy-five of these patients were hypoglycemic due to antidiabetic drugs. When the patients were evaluated according to the antidiabetic drugs, 47 (62.6%) patients were using insulin, 11 (14.6%) patients were using insulin and oral antidiabetic drugs, and 17 (22%) patients were using only oral antidiabetic drugs. The length of stay for the patients who were followed up and discharged in the emergency department ranged from 2 hours to 24 hours. The mean follow-up time was 9.4 hours in this patient group. One of the hospitalized patients (1.3%) died.

Conclusion
Hypoglycemia is a life-threatening antidiabetic drug toxicity. Patients taking these drugs should be informed about the symptoms of hypoglycemia.

Keywords

Diabetes mellitus, hypoglycemia, insulin, oral antidiabetic drug, toxicology

References

• 1. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002;(25):1551–6.
• 2. Türk Endokronoloji ve Metabolizma Derneği. (2011) TURDEP-II Sonuçları. The web site: http://endokrin.org. tr/files/file/TURDEP_II_2011.pdf
• 3. Sharma DC, Asirvatham A, Singh P. Dose modification of antidiabetic agents in patients with type 2 diabetes mellitus and heart failure. Indian J Endocrinol Metab. 2017;(21): 618–29.
• 4. Whipple AO. The surgical therapy of hyperinsulinism. J Int Chir 1938; (3):237–76.
• 5. Keskin Ö, Küçükardalı Y, Kalemoğlu M. Hypoglycemia at Emergency Care. Medeniyet Med J. 2004;(9):37-9
• 6. Davis SN, Galassetti P, Wasserman DH, Tate D. Effects of gender on neuroendocrine and metabolic counterregulatory responses to exercise in normal man. J Clin Endocrinol Metab 2000; (85):224-230
• 7. Davis SN, Cherrington AD, Goldstein RE, Jacobs J, Price L. Effefts of insulin on the counterregulatory response to equivalent hypoglycemia in normal females. Am J Physiol. 2000;(265):680–9.
• 8. American Diabetes Association. “Standards of medical care in diabetes-2014.” Diabetes Care 2014;(37):14–80.
• 9. International Diabetes Federation. Managing Older People with Type 2 Diabetes Global Guideline, 2013. Available at: http://www.idf.org/sites/default/files/IDFGuideline-for-older-people-T2D.pdf
• 10. SM Eleff, C Borel, WR Bell, DM Long. Acute management of intracranial hemorrhage in patients receiving thrombolytic therapy. Neurosurgery 1990;(26):867–9.
• 11. Colak S, Erdogan MO, Sekban H, et al. Emergency diagnosis of upper gastrointestinal bleeding by detection of haemoglobin in nasogastric aspirate. J Int Med Res. 2013; (41):1825–9
• 12. Wiethop BV, Cryer PE. Alanine and terbutaline in treatment of hypoglycemia in IDDM. Diabetes Care 1993;(16):1131–6.
• 13. Yu O, Azoulay L, Yin H, Filion KB, Suissa S. Sulfonylureas as initial treatment for type 2 diabetes and the risk of severe hypoglycemia. Am J Med. 2018;(131):317-22
• 14. Weinstock RS , DuBose SN , Bergenstal RM , Chaytor NS , Peterson C , Olson BA , et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2015;(39):603–10.
• 15. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;(26):1902–12.
• 16. American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes—2019. Diabetes Care 20119;(42):61-70