{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:34:53Z","timestamp":1761896093703},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:00:00Z","timestamp":1436832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Italian Ministry of Education and Research","award":["SDP: PRIN grant 2010YK7Z5K_006"],"award-info":[{"award-number":["SDP: PRIN grant 2010YK7Z5K_006"]}]},{"name":"Italian Ministry of Education and Research","award":["RM: PRIN grant 2010JS3PMZ_002"],"award-info":[{"award-number":["RM: PRIN grant 2010JS3PMZ_002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hypoglycaemia is a major burden of the pharmacological therapy of diabetes and is associated with increased morbidity, mortality and treatment costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We screened all admissions to the emergency room of the Pisa University Hospital from 1 January 2009 to 31 December 2013, selecting individuals with a discharge diagnosis of hypoglycaemia. We retrieved 500 admissions involving adult diabetic patients: age 71\u2009\u00b1\u200916\u00a0years; M\/F 50.2\/49.8%; 70.2% type 2 diabetes (T2DM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among T2DM, 42.2% were on insulin, 10.8% on insulin plus oral anti\u2010diabetes drugs and 38.2% on oral anti\u2010diabetes drugs alone (92% sulphonylureas\/glinides\u2009\u00b1\u2009insulin\u2010sensitizers). Glibenclamide was the most frequently used sulphonylurea (69%). Individuals treated with oral anti\u2010diabetes drugs were older than those on insulin (79\u2009\u00b1\u200911 <jats:italic>versus<\/jats:italic> 74\u2009\u00b1\u200912\u00a0years; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Among patients taking sulphonylurea, 47% had estimated glomerular filtration rate &lt;60\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> and 13.5% had &lt;30\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>. In\u2010hospital admission occurred in 20% of cases. Hospitalized patients with T2DM were older than those discharged (80\u2009\u00b1\u200910 <jats:italic>versus<\/jats:italic> 76\u2009\u00b1\u200912\u00a0years, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and were on oral antidiabetic drugs in 54.8% of the cases, whereas 35.7% were on insulin (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and 8.3% on combined therapy. Notably, 93.5% of those on oral anti\u2010diabetic drugs were taking a secretagogue. Insulin\u2010treated subjects were younger than those treated with oral anti\u2010diabetic drugs alone (77\u2009\u00b1\u200912 <jats:italic>versus<\/jats:italic> 82\u2009\u00b1\u20097\u00a0years; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.02). The mean in\u2010hospital annual mortality rate was 85 deaths per 1000 patients\u2010year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results support the recommendation that the risk associated with insulin and insulin\u2010secretagogues should be carefully assessed, particularly when prescribed in vulnerable patients with T2DM. 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