Hypoglycaemia: ACE inhibitors increased severe hypoglycaemia.

Clinical bottom line (level 3b)

  1. 1% of diabetic patients taking insulin or oral antidiabetic drugs were hospitalised with severe hypoglycaemia.
  2. Diabetic patients taking insulin or oral antidiabetics were at an increased risk of hospitalisation with severe hypoglycaemia if they: took ACE inhibitors, used insulin, used cardiovascular drugs, had diabetes for less than three years or had poor glycaemic control.
Morris et al: Diabetes Care 1997; 20 (9): 1363-1367
Expires February 2003

The study

Case-control study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: data was taken from the Diabetes Audit and Research in Tayside, Scotland (DARTS) database, which has data from patient records, prescriptions, discharge notes from hospital, records of patients attending a community retinopathy screening mobile eye van and hospital biochemistry data

504 patients (aged range 12 to 88 years; median 60, 61% male) hypoglycaemia

Excluded if
  • deliberate self-poisoning with insulin and oral hypoglycaemia agents
  • already inpatients at the hospital within one month of the date of admission for hypoglycaemia


    • Cases: 64 patients (61% male, mean age 60): admitted to hospital with severe hypoglycaemia requiring external assistance to affect recovery
    Controls: 440 patients (60% male, mean age 61): age-sex matched controls who use either insulin or oral hypoglycaemics


    Conditional logistic regression was used to adjust for confounding factors.

    Outcomes studied:
  • hospital admission with severe hypoglycaemia

    • The evidence

    Patient expected event rate for hospital admission with severe hypoglycaemia: 1.00%
    risk factor hospital admission with severe hypoglycaemia
    present    		 hospital admission with severe hypoglycaemia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    ACE inhibitor use 7 19 4.30
    (1.20 to 16.0)
    no ACE inhibitor use 57 421

    risk factor hospital admission with severe hypoglycaemia
    present    		 hospital admission with severe hypoglycaemia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    treatment- insulin users 48 174 3.10
    (1.10 to 9.00)
    no treatment- insulin users 16 266

    risk factor hospital admission with severe hypoglycaemia
    present    		 hospital admission with severe hypoglycaemia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    cardiovascular drug use 38 211 3.20
    (1.20 to 5.30)
    no cardiovascular drug use 26 229

    risk factor hospital admission with severe hypoglycaemia
    present    		 hospital admission with severe hypoglycaemia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    duration of diabetes 7 60 3.60
    (1.20 to 11.0)
    no duration of diabetes 57 380

    risk factor hospital admission with severe hypoglycaemia
    present    		 hospital admission with severe hypoglycaemia
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (% CI)
    glycaemic control 15 71 3.00
    (1.00 to 9.00)
    no glycaemic control 49 369

    Citation

    1. Morris AD, Boyle DIR, McMahon AD, et al: ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. Diabetes Care 1997; 20 (9): 1363-1367
    Contributor: Clare Wotton and Bob Phillips, February 2000
    Reviewer:

    Clinical Question.
    Patient diabetes
    Intervention or Exposure ACE inhibitor use
    Comparison no ACE inhibitor use
    Outcome hypoglycaemia