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Abstract
BackgroundAlmost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.MethodsThe study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients’ data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997–1998 in the same region.ResultsIn January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4% (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7% (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95% CI: 0.094–0.136) to 0.082 (0.073–0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095–0.141) to 0.037 (0.003–0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.ConclusionsAlthough from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.
Highlights
Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland
Severe hypoglycemia events in people with diabetes account for 0.5% to 1.02% of all emergency ambulance call outs in the UK per annum [10,11,12,13] where the frequency of severe hypoglycemia and its treatment by emergency medical services has been surveyed by opportunistic examination of ambulance records [10, 11]
Data on social deprivation were available for the 2011–12 cohort using the Scottish index of multiple deprivation (SIMD) which is derived from the postcode via the community health index register [14]
Summary
Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. The present populationbased data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes. Population-based studies of emergency medical services utilisation [9] have reported the incidence of hypoglycemia requiring emergency treatment in people with type 1 diabetes to be between 0.08 and 0.49 events per person per year. Severe hypoglycemia events in people with diabetes account for 0.5% to 1.02% of all emergency ambulance call outs in the UK per annum [10,11,12,13] where the frequency of severe hypoglycemia and its treatment by emergency medical services has been surveyed by opportunistic examination of ambulance records [10, 11]. The accuracy and validity of many such surveys were limited by inadequate study design and retrospective review of incomplete data
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