Sulfonylurea monotherapy and emergency room utilization among elderly patients with type 2 diabetes

• Sulfonylureas (SU) are commonly used oral anti-diabetic agents known to cause hypoglycemia.
• We conducted a retrospective cohort study to evaluate association of SU use and emergency room (ER) utilization among elderly patients with type 2 diabetes.
• Our results suggest that compared to other patients, those who were on SU were more likely to have an ER visit.

AimIn elderly Americans with type 2 diabetes, use of insulin and oral antidiabetic drugs (OADs) accounts for almost one-fourth of drug adverse event-related hospitalizations. It is not clear, however, if sulfonylureas (SUs), frequently prescribed OADs known to cause hypoglycemia, increase the risk of emergency room (ER) visits compared to other OADs. The aim of this study was to compare the emergency room utilization between US elderly patients with diabetes on SU monotherapy vs. other non-SU monotherapies.MethodsThis retrospective cohort study was conducted using MarketScan® database (2009–10) and aimed to evaluate the association between use of SU and ER visits. The analysis included 28,533 patients (aged ≥65 years) receiving SU monotherapy at baseline and 1:1 propensity score (PS)-matched group receiving monotherapy with other OADs. ER utilization was determined during a 1-year follow-up period.ResultsThe SU and non-SU groups were overall well balanced after PS matching. The mean (SD) number of ER visits during the follow-up was 0.56 among users of SU users compared to 0.49 (P < 0.0001) among non-users. In multivariable analysis, the adjusted odds ratios for ≥2 ER visits were 1.21 (95% CI = 1.13–1.30) comparing SU users to non-users and 1.31 (95% CI = 1.21–1.41) for SU vs. metformin users.ConclusionElderly patients with type 2 diabetes on SU monotherapy were more likely to use ER than those on other monotherapies. Further studies are needed to confirm our findings and evaluate other factors associated with ER visits.