A Case of Prolonged Severe Hypoglycemia with Elevated Plasma Concentration of Mitiglinide

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  • 血中ミチグリニド濃度高値を呈した遷延性重症低血糖の1例

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Mitiglinide is a rapid- and short-acting insulinotropic SU receptor ligand whose blood concentration rises rapidly after oral administration, falling quickly thereafter. Mitiglinide thus rarely causes prolonged hypoglycemia. We report a subject with diabetes having prolonged hypoglycemia induced by mitiglinide.<br> An 80-year-old woman admitted in a hypoglycemic coma had been diagnosed with diabetes at age 50 and had undergone treatment with mitiglinide at 30 mg/day for 5 years. Her right kidney was removed at age 73 due to a tumor. She ate breakfast and took medication, including mitiglinide, as usual, but these were discontinued after admission. Some 30 hours after the last mitiglinide intake, she went into a hypoglycemic coma again with high IRI, C-peptide, and mitiglinide blood concentrations suggestive of prolonged hypoglycemia induced by mitiglinide. Mitiglinide is predominantly metabolized in the liver, but renal impairment did not explain the prolonged high concentration. We analyzed the genes involved in drug metabolism, transport, and excretion using the Affymetrix Targeted Genotyping System, but results were not contributory. This case thus shows that mitiglinide may induce prolonged hypoglycemia. Careful attention must therefore be paid when mitiglinide is prescribed to elderly subjects with renal impairment.<br>

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