The management of severe hypoglycemia by the emergency system: The HYPOTHESIS study

• DOI: 10.1016/j.numecd.2014.05.012
• Publication Date: 2014-05-29T00:18:18Z
• Authors: G. Marchesini; G. Veronese; Gabriele Forlani; Giulia Forlani; L.M. Ricciardi; A. Fabbri
• Keywords: Aged, 80 and over; Male; Emergency Medical Services; Administration, Oral; Comorbidity; Middle Aged; Hypoglycemia; Diabetes; Hypoglycemic agents; Emergency Services; Hypoglycemia; White People; 3. Good health; Hospitalization; 03 medical and health sciences; 0302 clinical medicine; Diabetes Mellitus, Type 2; Italy; Risk Factors; Humans; Insulin; Female; Hospital Mortality; Aged; Retrospective Studies

Severe hypoglycemia is not rare in diabetes and markedly impacts on health resource use. We aimed to describe the characteristics of patients attending emergency departments (EDs) following a severe episode of hypoglycemia, the factors associated with the management of events and the final outcome.We carried out a retrospective analysis of cases attending 46 Italian EDs for hypoglycemia from January 2011 to June 2012. A total of 3753 records were retrieved from the databases of the participating centers, part of a network repeatedly involved in collaborative studies; 3516 episodes occurred in subjects with diabetes (median age, 76 years; range, 1-102). Comorbidities were recorded in 2320 (65.9%) diabetes cases; association with trauma or road accidents in 287 (8.2%) and 47 (1.3%), respectively. Patients were treated with insulin (49.8%), oral agents (31.4%), or combination treatment (15.1%). The event required assistance by the out-of-hospital Emergency services in 1821 cases (51.8%). Following the ED visit, admission to hospital departments was deemed necessary in 1161 cases (33.1%). Diabetes treatment (oral agents: OR, 1.63; 95% confidence interval (CI), 1.37-1.94), increasing age (OR, 1.39; 95% CI, 1.31-1.48) and the number of comorbidities (OR, 1.51; 95% CI, 1.38-1.66) were the main drivers of admission. The in-hospital death rate was 10%, associated with the number of comorbidities (OR, 1.28; 95%CI, 1.01-1.63).Severe hypoglycemia requiring referral to EDs is associated with a significant work-up of the Emergency services and a remarkable in-hospital death rate in frail individuals with diabetes.