Michael Erdman, PharmD
University of Florida
Indianapolis, Indiana
Disclosure information not submitted.
Julia Lessing
BS, PharmD Candidate 2022
University of Florida College of Pharmacy, United States
Disclosure information not submitted.
Michael Pizzi, DO, PhD
Assistant Professor
University of Florida, United States
Disclosure information not submitted.
Title: Predictors of Hypoglycemia in Patients Receiving Enteral Glyburide after Ischemic Stroke
INTRODUCTION/HYPOTHESIS: Sulfonylureas have recently been shown to be effective in decreasing cerebral edema after ischemic stroke by antagonizing the sulfonylurea-1 (SUR-1) receptor in ischemic neurons, capillaries and astrocytes. Though a parenteral glyburide formulation has been studied in a large randomized clinical trial, it is not commercially available in the United States. Enteral glyburide is available, though a lack of safety data, especially as it relates to hypoglycemia, limits its use. The purpose of this study was to identify risk factors for hypoglycemia in patients receiving enteral glyburide in the first several days after an ischemic stroke.
Methods: This was a retrospective chart review of patients admitted for acute ischemic stroke from January 2016 to July 2020 who received glyburide due to being at increased risk of malignant cerebral edema. Patients were then grouped according to whether they experienced hypoglycemia (blood glucose < 70 mg/dL) and a binary logistic regression was performed on non-collinear variables with a p < 0.1.
Results: One hundred and forty three patients were included, of which 37 had at least one hypoglycemic event. Patients who became hypoglycemic were less likely to have a past medical history of diabetes (16% vs. 44%, p = 0.003), had a lower median initial systolic blood pressure (SBP) (154 [127-168] vs. 160 [141-178] mmHg, p = 0.035), and lower median blood glucose (BG) prior to their first glyburide administration (110 [10-131] vs. 135 [112-182] mg/dL, p < 0.001). Blood glucose immediately prior to first glyburide administration, initial SBP upon hospital presentation, past medical history of diabetes, weight and initial NIH stroke scale score were entered into the model, of which only BG immediately prior to first glyburide administration was found to be predictive of hypoglycemia (OR 0.987 per 1 mg/dL increase in BG, 95 % CI 0.987-1.000, p = 0.046).
Conclusions: Blood glucose immediately prior to the first dose of glyburide was a reliable predictor of hypoglycemia in patients receiving enteral glyburide after ischemic stroke. Providers should consider withholding glyburide in patients with a BG < 130 mg/dL prior to administration.