Page 109 - ITPS-8-2

INNOSC Theranostics and
Pharmacological Sciences Drug-induced hypoglycemia

However, the use of combination therapy in T2DM combined intake of voglibose and metformin hydrochloride
comes with risks. Hypoglycemia, one of the most in a patient with T2DM and renal impairment. The case
concerning complications associated with antidiabetic highlights the challenges faced in achieving optimal
agents, is characterized by abnormally low blood glucose glycemic control in patients with multiple comorbidities,
levels. Hypoglycemia can have serious consequences, in the presence of renal impairment. The findings from this
ranging from mild symptoms such as confusion and case report contribute to the growing body of literature on
shakiness to severe neurological impairment, coma, or the risks and considerations associated with combination
death if left untreated. The risk of hypoglycemia is therapy in patients with T2DM and renal impairment.
6,7
further increased in patients with renal impairment due to
alterations in drug clearance and pharmacokinetics. 8,9 2. Case presentation
Renal impairment is a common comorbidity in patients A 61-year-old man with a history of type 2 diabetes mellitus
with T2DM, affecting approximately 40% of this patient (T2DM) and hypertension presented to the hospital with
population. 10,11 The kidneys are crucial in the elimination diminished consciousness, slurred speech, and profuse
of drugs from the body, and any impairment in renal sweating. His antidiabetic regimen included glimepiride (2 mg),
function can lead to the accumulation of drugs and their metformin (500 mg), and voglibose (0.2 mg). Two months
metabolites, potentially increasing the risk of adverse prior, the patient had experienced hydroureteronephrosis
effects. Moreover, in patients with renal impairment, dose calculi, acute-on-CKD, and urosepsis (Tables 1 and 2).
12
adjustments and careful selection of antidiabetic agents
must be considered to prevent drug-induced hypoglycemia Table 1. Patient characteristics and baseline parameters
or other adverse events.
Parameter At presentation At discharge/follow‑up
Voglibose, an alpha-glucosidase inhibitor, delays the
absorption of carbohydrates in the intestine, thereby Age 61 years -
reducing postprandial hyperglycemia. 13,14 Metformin, a Sex Male -
biguanide, is commonly used as a first-line therapy in HbA1c 9.4% 7.6%
T2DM management owing to its ability to reduce hepatic Fasting glucose 50 – 70 mg/dL 110 – 130 mg/dL
glucose production and improve insulin sensitivity. 10,15 Both Postprandial Not assessed 140 – 180 mg/dL
voglibose and metformin have shown efficacy in improving glucose
glycemic control; however, their use in combination therapy Serum creatinine 2.6 mg/dL 2.4 mg/dL
and the potential associated risks, particularly in patients eGFR 26 mL/min/1.73 m² 33 mL/min/1.73 m²
with renal impairment, have not been extensively studied. 14,15 (Stage 3b CKD)
This case report describes the clinical presentation Blood urea nitrogen 60 mg/dL Not reassessed
of a 61-year-old male patient with a medical history of Comorbidities Hypertension, CKD, -
hypertension and T2DM. He developed hypoglycemia and nephrolithiasis
while taking a combination of voglibose and metformin Abbreviations: CKD: Chronic kidney disease; eGFR: Estimated
hydrochloride for glycemic control. The patient also had glomerular filtration rate; HbA1c: Hemoglobin A1c.
a history of urosepsis, acute-on-chronic kidney disease
(CKD), and hydroureteronephrosis calculi, which may have Table 2. Medication regimens and adjustments
contributed to altered drug clearance and pharmacokinetics, Therapy Dosage Indication Outcome
thereby increasing the risk of hypoglycemia.
Glimepiride 2 mg/day T2DM Discontinued due to
This case report primarily aimed to highlight the hypoglycemia
potential risks associated with combination therapy for Metformin 500 mg/day T2DM Discontinued due
diabetes, particularly in patients with renal impairment. to CKD
This case underscores the importance of close monitoring Voglibose 0.2 mg/day Postprandial glucose Discontinued
of blood glucose levels and renal function in patients with control
T2DM and renal impairment to prevent drug-induced Linagliptin 5 mg/day T2DM with CKD Initiated, improved
hypoglycemia. Another aim is to raise awareness among glycemic control
healthcare providers regarding the need for individualized Losartan 50 mg/day Hypertension Continued
treatment plans and cautious selection of antidiabetic Amlodipine 5 mg/day Hypertension Continued
agents in this patient population.
Atorvastatin 10 mg/day Dyslipidemia Continued
To the best of our knowledge, this is one of the few Abbreviations: CKD: Chronic kidney disease; T2DN: Type 2 diabetes
reported cases of hypoglycemia associated with the mellitus.

Volume 8 Issue 2 (2025) 103 doi: 10.36922/itps.7355