Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Amit Garg


Background: In the last decade, several new antihyperglycemic medications have been approved to treat people with diabetes. However, the hypoglycemia risk of these medications in older adults in routine clinical practice remains unclear. Further, there is limited understanding as to how these medications are being prescribed to older adults in our region.

Methods: We carried out retrospective, population-based studies of adults age 66 and older in Ontario, Canada using linked healthcare databases. We first investigated the real-world hypoglycemia risk of 2 antihyperglycemic medications – glyburide and modified-release gliclazide. In an ecological study, we then examined trends in antihyperglycemic medication prescriptions, and in this setting, investigated hospital encounters for hypoglycemia.

Results: Initiating glyburide vs gliclazide as monotherapy or in the presence of metformin was associated with a significantly higher risk of a hospital encounter with hypoglycemia. Over the last decade, newer and safer antihyperglycemic medications have been prescribed to older adults in our region. In this setting, the overall percentage of patients with a hospital encounter with hypoglycemia has declined.

Conclusions: Antihyperglycemic medications differ in their real-world hypoglycemia risk in older patients. In the setting of newer and safer antihyperglycemic medications, encounters for hypoglycemia have declined.