Journal article
Glycemic Control and Hypoglycemia in Veterans Health Administration Patients Converted from Glyburide to Glipizide
Journal of managed care pharmacy, Vol.17(9), pp.664-671
11/01/2011
DOI: 10.18553/jmcp.2011.17.9.664
PMCID: PMC10438102
PMID: 22050391
Abstract
BACKGROUND: In 2009, the Veterans Health Administration (VHA) released a national bulletin regarding the risk of hypoglycemia associated with the use of glyburide in elderly patients with renal dysfunction. Providers were encouraged to avoid glyburide and use glipizide in patients with a calculated creatinine clearance (CrCl) of less than 50 mL per minute. Since this initiative, many veterans were converted by their providers from glyburide to glipizide regardless of renal impairment.
OBJECTIVES: To (a) identify whether hemoglobin A1c remained equivalent in patients converted from glyburide to glipizide, (b) evaluate the prevalence of hypoglycemia during treatment with glyburide or glipizide, (c) compare change in glycemic control for renally impaired versus nonimpaired patients, and (d) analyze dosage conversion ratios selected by providers and measures of patient follow-up after conversion including time until A1c measurement and number of glipizide dose titrations.
METHODS: This was a single-center, retrospective analysis of veterans converted from glyburide to glipizide from January 1, 2008, through May 31, 2010, who had documented A1c values concurrent with glyburide and glipizide use. A 2-sided equivalence analysis was used for the primary outcome. Equivalence was defined as a change in mean A1c of 0.2. Hypoglycemia was defined as blood glucose of less than 70 mg per dL, symptoms of hypoglycemia, or hypoglycemia that led to a fall, loss of consciousness, emergency room visit, hospitalization, or death. The pre- to post-conversion change in rates of hypoglycemia was tested for significance using a McNennar's test.
RESULTS: In the 141 (99.3% male, 53.9% CrCl < 50 mL per minute, mean age = 74.0 years) patients meeting inclusion criteria between 2008-2010, the average change in A1c (+ 0.34) was nonequivalent after conversion from glyburide to glipizide (7.08% vs. 7.42%, respectively). Hypoglycemia occurred more frequently during treatment with glyburide than glipizide (31.2% vs. 12.8%, respectively, P < 0.001). Mean dose conversion ratios were consistent with VHA recommendations (1 mg per day glyburide = 1.26-1.55 mg per day glipizide).
CONCLUSIONS: Conversion from glyburide to glipizide was associated with an increase in A1c, but the incidence of hypoglycemia was reduced. Results of this study are consistent with the recommendation of the American Diabetes Association and European Association for the Study of Diabetes to use second-generation sulfonylureas other than glyburide. Patients converted to glipizide should be monitored closely to adjust therapy as appropriate to maintain glycemic control. J Manag Care Pharm. 2011;17(9):664-71 Copyright(C)2011, Academy of Managed Care Pharmacy. All rights reserved.
Details
- Title: Subtitle
- Glycemic Control and Hypoglycemia in Veterans Health Administration Patients Converted from Glyburide to Glipizide
- Creators
- Rachel A. Skoff - Iowa City VA Health Care SystemNancee V. Waterbury - Iowa City VA Hlth Care Syst, Iowa City, IA 52246 USARobert F. Shaw - Iowa City VA Hlth Care Syst, Iowa City, IA 52246 USAJason A. Egge - Iowa City VA Hlth Care Syst, Iowa City, IA 52246 USAMatthew Cantrell - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of managed care pharmacy, Vol.17(9), pp.664-671
- Publisher
- Acad Managed Care Pharmacy
- DOI
- 10.18553/jmcp.2011.17.9.664
- PMID
- 22050391
- PMCID
- PMC10438102
- ISSN
- 1083-4087
- eISSN
- 1944-706X
- Number of pages
- 8
- Language
- English
- Date published
- 11/01/2011
- Academic Unit
- Pharmacy Practice and Science
- Record Identifier
- 9984366016402771
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