Fluoroquinolones and the risk of severe hypoglycaemia among sulphonylurea users: Population-based cohort study.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883645 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1326 (Electronic) Linking ISSN: 14628902 NLM ISO Abbreviation: Diabetes Obes Metab Subsets: MEDLINE

Original Publication: Oxford : Wiley-Blackwell, c1999-

Hypoglycemia*/chemically induced ; Hypoglycemia*/epidemiology ; Sulfonylurea Compounds*/adverse effects ; Fluoroquinolones*/adverse effects ; Hypoglycemic Agents*/adverse effects ; Diabetes Mellitus, Type 2*/drug therapy; Humans ; Female ; Male ; Middle Aged ; Aged ; Cohort Studies ; Amoxicillin/adverse effects ; United Kingdom/epidemiology ; Risk Factors ; Adult ; Anti-Bacterial Agents/adverse effects

Aim: Fluoroquinolone-related hypoglycaemia is rare but may become clinically relevant in individuals at high baseline hypoglycaemic risk, such as patients with diabetes using sulphonylureas. Our population-based cohort study assessed whether fluoroquinolones are associated with an increased risk of severe hypoglycaemia compared with amoxicillin among patients treated with sulphonylureas.
Materials and Methods: Using the UK's Clinical Practice Research Datalink Aurum linked to hospitalization and vital statistics data, we assembled a base cohort of patients who initiated second-generation sulphonylureas (1998-2020). The study cohort included patients initiating either fluoroquinolones or amoxicillin while on sulphonylureas. Using an intent-to-treat exposure definition, we assessed the 30-day risk of severe hypoglycaemia (hospitalization with or death because of hypoglycaemia) associated with fluoroquinolones compared with amoxicillin. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of severe hypoglycaemia after 1:5 matching on previous sulphonylurea use and propensity scores. Secondary analyses were stratified by demographics and glycated haemoglobin.
Results: Overall, 143 417 patients initiated fluoroquinolones (n = 13 123) or amoxicillin (n = 130 294) while on sulphonylureas. Compared with amoxicillin, fluoroquinolones were not associated with the risk of severe hypoglycaemia (HR, 1.17; 95% CI, 0.91-1.50). Fluoroquinolones were associated with an increased risk in patients <65 years (HR, 2.90; 95% CI, 1.41-5.97) but not in those ≥65 years (HR, 1.03; 95% CI, 0.79-1.35) in stratified analyses. There was no evidence of effect modification by sex or glycated haemoglobin.
Conclusions: In patients using second-generation sulphonylureas, fluoroquinolones were not associated with an increased risk of severe hypoglycaemia compared with amoxicillin. An increased risk among younger adults is possible.
(© 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

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PJT-165882 Canada CAPMC CIHR; PJT-165882 Canada CAPMC CIHR

Keywords: antidiabetic drug; hypoglycaemia; pharmaco‐epidemiology; real‐world evidence; sulphonylureas

0 (Sulfonylurea Compounds)
0 (Fluoroquinolones)
0 (Hypoglycemic Agents)
804826J2HU (Amoxicillin)
0 (Anti-Bacterial Agents)

Date Created: 20240503 Date Completed: 20240709 Latest Revision: 20240709

20240709

10.1111/dom.15627

38698651