Vandenberghe Frederik, Challet Corinne, Maitrejean Mathias, Christin Laurent, Schaad Nicolas
Pharmacie Interhospitalière de la Cote, Morges, Switzerland.
Medical Analysis Laboratory, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland, Nyon, Switzerland.
Eur J Hosp Pharm. 2019 Jul;26(4):199-204. doi: 10.1136/ejhpharm-2017-001375. Epub 2018 Mar 17.
Hospital admission rates for hypoglycaemia now exceed those for hyperglycaemias among older adults. A growing number of reports associating hypoglycaemia with non-antidiabetic drugs have been published. Clinical pharmacists are often faced with hypoglycaemia in patients taking multiple medications. This study assessed the potential relationship between prescribed drugs and episodes of hypoglycaemia during hospitalisation.
Point-of-care blood glucose values and prescribed drugs were analysed in patients admitted to a regional hospital. Hypoglycaemia cases were defined as patients with at least one hypoglycaemic event (random glucose value ≤3.9 mmol/L), and normoglycaemic cases as those with random glucose concentrations within the range of 4.5-5.8 mmol/L. Analyses were carried out using multivariate logistic regressions and Cox proportional hazard models.
373 patients (53% males; median age=74 years) were included in the analysis and of these, 64 (17%) had at least one hypoglycaemic event. Patients who experienced a hypoglycaemic event had a longer length of stay (median=10 vs 7 days, p<0.01) and a higher rate of antidiabetic drugs prescription (83% vs 37%, p<0.01). The number of non-antidiabetic drugs was associated with an increased risk of hypoglycaemia during hospitalisation (HR 2.3, 95% CI 1.4 to 4, p<0.01). After adjusting by confounders, heparin and pantoprazole were found to be associated with hypoglycaemia.
The relationship between hypoglycaemia and polypharmacy reinforces the advice to limit polymedication as much as possible, especially in elderly patients. This result underlines the potential involvement of clinical pharmacists with the aim to reduce the risk of hypoglycaemia during hospitalisation.
在老年人中，低血糖的住院率现已超过高血糖的住院率。越来越多关于低血糖与非抗糖尿病药物关联的报告已发表。临床药师在面对服用多种药物的患者时经常会遇到低血糖情况。本研究评估了住院期间处方药物与低血糖发作之间的潜在关系。
对一家地区医院收治的患者的即时血糖值和处方药物进行分析。低血糖病例定义为至少有一次低血糖事件（随机血糖值≤3.9 mmol/L）的患者，血糖正常病例定义为随机血糖浓度在4.5 - 5.8 mmol/L范围内的患者。使用多变量逻辑回归和Cox比例风险模型进行分析。
373名患者（53%为男性；中位年龄 = 74岁）纳入分析，其中64名（17%）至少有一次低血糖事件。经历低血糖事件的患者住院时间更长（中位时间 = 10天对7天，p < 0.01），抗糖尿病药物处方率更高（83%对37%，p < 0.01）。非抗糖尿病药物的数量与住院期间低血糖风险增加相关（风险比2.3，95%置信区间1.4至4，p < 0.01）。在对混杂因素进行调整后，发现肝素和泮托拉唑与低血糖有关。
低血糖与多重用药之间的关系强化了尽可能限制联合用药的建议，尤其是在老年患者中。这一结果强调了临床药师为降低住院期间低血糖风险而可能发挥的作用。
