The clinical course of patients with type 2 diabetes presenting to the hospital with sulfonylurea-induced hypoglycemia.

BACKGROUND: This study describes the clinical course of adult patients with type 2 diabetes taking a sulfonylurea and presenting to the hospital with severe hypoglycemia. SUBJECTS AND METHODS: This was a retrospective chart review of all patients >15 years of age with type 2 diabetes and taking a sulfonylurea who presented to the emergency services of Auckland City Hospital over a 6-year period with severe hypoglycemia. RESULTS: One hundred eighty-five patients met the inclusion criteria. Their mean ± SD age was 71 ± 11 years, and known duration of diabetes was 14.7 ± 10 years. Of the patients, 167 had micro- and/or macrovascular complications of diabetes, and one-third had had a previous admission with hypoglycemia. Only 61 patients (33%) had a glomerular filtration rate of >60 mL/min. The length of stay was not correlated with admission creatinine level (highest tertile of creatinine, 71 ± 93 h; lowest tertile, 51 ± 79 h). Recurrent in-hospital hypoglycemia occurred in over one-third of patients, and 28 (15%) were re-admitted to the hospital within 28 days of discharge for various reasons, including further hypoglycemia in 13 patients. Two patients died during their admission. CONCLUSIONS: Patients with type 2 diabetes presenting to the hospital with sulfonylurea-associated hypoglycemia have a high burden of comorbidity, require a long hospital stay, and are at risk of subsequent re-admission to hospital. Careful evaluation of their best future treatment strategies must be undertaken taking account of their comorbidities, including their renal function.

Pioglitazone in acromegaly - an open-label, prospective study.

OBJECTIVE: Preclinical studies demonstrate that thiazolidinediones (TZDs) decrease growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, suggesting that they might be effective treatments for acromegaly. This study investigated the effect of pioglitazone on biochemical indices of disease activity in acromegaly. DESIGN AND PARTICIPANTS: This was a 4-month open-label prospective study in 16 patients with active acromegaly who were attending public hospital endocrinology clinics. METHODS: The intervention was pioglitazone 45 mg/day. The primary outcome was change in serum IGF-1; the secondary outcome was change in area under the curve of glucose-suppressed GH. RESULTS: Serum IGF-1 did not change during treatment with pioglitazone (P = 0·95). After 4 months, the mean (95% CI) change from baseline was -1 µg/l (-51, 49). GH levels following oral glucose loading were unchanged during pioglitazone therapy. After 4 months, the mean (95% CI) change from baseline in area under curve for glucose-suppressed GH was 31 µg/l (-75, 138, P = 0·54). CONCLUSIONS: Short-term treatment with conventional doses of pioglitazone did not improve biochemical measures of disease activity in acromegaly.