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Hypoglycemic coma in an elderly adult switched from twice-daily vildagliptin to once-daily glimepiride to improve drug adherence

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Abstract

Background

Elderly adults with diabetes are at increased risk of severe hypoglycemia and hypoglycemic coma due to various conditions including decline in cognitive function, reduced activity of daily living (ADL) and reduced renal function; special cautions are, therefore, recommended to avoid these life-threatening events.

Case presentation

A 92-year-old female was admitted to our institution because of severe coma. Upon arrival, her serum C-peptide was 1.64 ng/mL despite low plasma glucose (24 mg/dL) and serum glimepiride (40.85 ng/mL). She had past history of compression fracture of her lumbar spine, which substantially affected her ADL. Her score on the dementia assessment sheet for community-based integrated care system-8 items (DASC-8) was 26 points. She had been receiving 12 oral medications for diabetes, essential hypertension, chronic gastritis and constipation from her nearby clinic. Her physician-in-charge had found that she was not taking her medications properly and simplified her prescription regimen to 3 oral medications with vildagliptin 50 mg twice daily replaced by glimepiride 3 mg once daily and asked her son to assist in taking the drugs 6 days before her admission to our hospital. While her consciousness level was improved to some extent, she was transferred to a long-term care bed hospital because it had become too difficult to care for her at home.

Conclusions

It is important to note that anti-diabetes drugs should be carefully selected based on each patient’s cognitive function and ADL, and that the reasoning should be shared with the general practitioners involved to avoid severe hypoglycemic events.

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Data availability

Clinical data from the corresponding author are available upon request.

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Acknowledgements

The authors also thank H. Tsuchida, J. Kawada and M. Kato for their technical assistance, and M. Yato, Y. Ogiso and M. Nozu for their secretarial assistance.

Funding

This work was supported by grants from Japan Society for the Promotion of Sciences (JSPS) [KAKENHI Grant 17K09825 (to D.Y.), 17K00850 (to K.I) and 18H02779 (to Y.H.)].

Author information

Author notes

  1. Shunsuke Tominari and Megumi Yasuda contributed equally to the work.

Authors and Affiliations

  1. Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Shunsuke Tominari, Megumi Yasuda, Takehiro Kato, Mayu Sakai, Sodai Kubota, Kenta Nonomura, Tokuyuki Hirose, Ken Takao, Yanyan Liu, Masami Mizuno, Takuo Hirota, Katsumi Iizuka, Tetsuya Suwa, Yukio Horikawa & Daisuke Yabe

Authors
  1. Shunsuke Tominari
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  2. Megumi Yasuda
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  3. Takehiro Kato
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Contributions

ST, MY, TK and DY contributed to the analysis, collection, and interpretation of data and writing of the manuscript. MS, SK, YL, KN, TH, MM, TH, KI, TS and YH contributed to the analysis, collection of data, and interpretation of data as well as critical revisions of the manuscript for important intellectual content, and contributed to the analysis, collection and interpretation of pathological data and critical revisions of the manuscript for important intellectual content. All authors approved the version to be published. TK and DY are the guarantors of this work.

Corresponding author

Correspondence to Takehiro Kato.

Ethics declarations

Conflict of interest

Author YH received a lecture fees from Kowa and MSD. Author DY received a research grant from TERUMO CORPORATION, lecture fees from Novo Nordisk Pharma, Nippon Boehringer Ingelheim and MSD, donations from Nippon Boehringer Ingelheim and endowed departments by commercial entities from ONO PHARMACEUTICAL CO LTD, Taisho Pharma CO Ltd, ARKRAY, Inc, Takeda Pharmaceutical Company Limited, Nippon Boehringer Ingelheim and Novo Nordisk Pharma. Author ST, MY, TK, MS, SK, YL, KN, TH, MM, TH, KI and TS declare that they have no conflict of interest. The authors declare that they have no competing interests relevant to this study.

Ethical approval

Formal ethics approval was waived for this paper by the ethics committee of Gifu University Graduate School of Medicine due to its being a case report.

Consent for publication

Written informed consent was obtained from the family for publication of this report; the patient died after her transfer to a long-term care bed hospital.

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Supplementary Information

Below is the link to the electronic supplementary material.

13340_2021_510_MOESM1_ESM.pptx

Supplementary Fig. 1 Imaging analysis of the patient’s brain upon her admission to our institution. A. Computer tomography (CT) scan shows no abnormalities except for diffuse brain atrophy. B. Magnetic resonance imaging (MRI) shows no cerebral hemorrhage or cerebral infarction, while the white matter abnormality is consistent with hypoglycemic coma (PPTX 228 KB)

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Tominari, S., Yasuda, M., Kato, T. et al. Hypoglycemic coma in an elderly adult switched from twice-daily vildagliptin to once-daily glimepiride to improve drug adherence. Diabetol Int 13, 295–299 (2022). https://doi.org/10.1007/s13340-021-00510-9

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  • DOI: https://doi.org/10.1007/s13340-021-00510-9

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