Prevalence of factitious hypoglycaemia associated with sulphonylurea drugs in France in the year 2000
Article first published online: 11 NOV 2002
British Journal of Clinical Pharmacology
Volume 54, Issue 5, page 548, November 2002
How to Cite
Trenque, T., Frances, C., Millart, H., Hoizey, G. and Germain, M. L. (2002), Prevalence of factitious hypoglycaemia associated with sulphonylurea drugs in France in the year 2000. British Journal of Clinical Pharmacology, 54: 548. doi: 10.1046/j.1365-2125.2002.01685.x
- Issue published online: 11 NOV 2002
- Article first published online: 11 NOV 2002
Hypoglycaemia presents important diagnostic and therapeutic problems. Severe and repetitive hypoglycaemic episodes without treatment may be difficult to explain. Failure to identify factitious hypoglycaemia may lead to laparotomy or pancreatectomy [1, 2].
To estimate the prevalence of factitious hypoglycaemia due to sulphonylurea drugs in patients with unexplained severe hypoglycaemia, we conducted a prospective study during the year 2000. Hypoglycaemic patients were recruited throughout France. Plasma was assayed for oral hypoglycaemic agents on the clinician’s request, using h.p.l.c. with u.v. detection. Fifty-six patients with unexplained hypoglycaemia were recruited. In seven of these patients (five women, two men), a sulphonylurea oral hypoglycaemic agent was detected (Table 1).
|Hypoglycaemic agent||Maximal concentrations observed||Therapeutic range||Elimination half-life|
|Glibenclamide (n = 4)||696 µg l−1||25–50 µg l−1||5 h−10 h|
|Glimepiride (n = 2)||418 µg l−1||300 µg l−1||5 h−9 h|
|Gliclazide (n = 1)||2.1 mg l−1||1.5 mg l−1||8 h−12 h|
Plasma concentrations were usually supra-therapeutic and concentrations up to 15 times the upper limit of the therapeutic range were observed.
In one 45-year-old patient, during hospitalization, we identified glibenclamide concentrations of 529 µg l−1 at 11.00 h (therapeutic concentration 25–50 µg l−1), of 696 µg l−1 at 22.00 h, of 154 µg l−1 at 06.15 h and of 367 µg l−1 at 08.00 h over a 2 day period.
Insulinoma has been suspected in such patients due to continued surreptitious consumption of medication during hospitalization.
Received •• 2002, accepted 7 August 2002
Thierry Trenque, MD, PhD, Pharmacovigilance Regional Centre, Centre Hospitalier Universitaire, 45 Rue Cognacq-Jay, 51092 Reims Cedex, France. Tel.: +33 3 26 78 77 80; Fax: +33 3 26 78 84 56; E-mail: firstname.lastname@example.org