Abstract
ObjectiveTo analyse changes in the characteristics of hypoglycaemic episodes treated in the emergency room of a tertiary hospital in Portugal between 2012 and 2016.Research Design and MethodsWe retrospectively analysed all emergency room reports for patients discharged with a diagnosis of hypoglycaemia between 2012 and 2016 and analysed demographic characteristics, type of diabetes and treatments, causes of hypoglycaemia and discharge destination. Patients without diabetes were excluded.ResultsIn total, 676 hypoglycaemic episodes were analysed. Most patients were female (59%) and the median age of the patients was 71 years (interquartile range, 57‐81). The proportion of hypoglycaemic episodes relative to all emergency episodes decreased from 1.5% in 2012 to 1.0% in 2016 (P < .001). The proportion of patients with type 1 diabetes increased from 15.6% to 23.8%, while that of patients with type 2 diabetes decreased from 80.3% to 72.3% (nonsignificant differences). There was an increase in the use of insulin (67.1% to 85.4%, P = .02) and a decrease in the use of insulin secretagogues (26.6% to 11.5%, P = .03) over the study period. The rate of hospitalization dropped significantly from 11% in 2012 to 4.3% in 2015 and 5.4% in 2016 (P = .02).ConclusionsDespite the increasing use of newer diabetes medications associated with a lower risk of hypoglycaemia, these episodes still require emergency care. The proportion of patients receiving insulin increased over the years, probably due to the slight increase in the prevalence of type 1 diabetes and the increasing replacement of secretagogues with insulin in type 2 diabetes.
Highlights
The proportion of emergency room (ER) visits for diabetic patients discharged with a diagnosis of hypoglycaemia at our hospital decreased from 2012 to 2016
Admissions for hypoglycaemia in a national US survey in Medicare beneficiaries performed between 1999 and 2011.16 This can be attributed to the greater proportion of patients achieving the recommended thresholds for HbA1c,2,19 given the increasing awareness in recent years about the benefits of good glycaemic control in the prevention of chronic diabetes complications
The median age of the patients in our series, 71 years (IQ, 57-81), is the same as that reported by Su et al[20] in a study of predisposing factors for hypoglycaemia in the ER but lower than that of 77.5 years reported in the HIPOS-ER study.[18]
Summary
Between 1999 and 2011, over 400,000 people were admitted to US hospitals with hypoglycaemia, outnumbering those admitted for hyperglycaemia.[16] Based on data for 2013-2014, hypoglycaemic episodes accounted for 13.3% of all ER visits for adverse drug events in the United States.[17] In Portugal, the HIPOS-ER (Hypoglycemia in Portugal Observational Study– Emergency Room) study showed that 0.074% of type 2 diabetic patients required emergency care for severe hypoglycaemia.[18] Dependence on others, type of diabetes, treatments, levels of consciousness on admission, causes of hypoglycaemia, and destination at discharge from the ER for all patients included and compared data over the 5 years analysed.
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