Geographical variation of diabetic emergencies attended by prehospital Emergency Medical Services is associated with measures of ethnicity and socioeconomic status

Abstract

Geographical variation of diabetic emergencies attended by prehospital emergency medical services (EMS) and the relationship between area-level social and demographic factors and risk of a diabetic emergency were examined. All cases of hypoglycaemia and hyperglycaemia attended by Ambulance Victoria between 1/01/2009 and 31/12/2015 were tabulated by Local Government Area (LGA). Conditional autoregressive models were used to create smoothed maps of age and gender standardised incidence ratio (SIR) of prehospital EMS attendance for a diabetic emergency. Spatial regression models were used to examine the relationship between risk of a diabetic emergency and area-level factors. The areas with the greatest risk of prehospital EMS attendance for a diabetic emergency were disperse. Area-level factors associated with risk of a prehospital EMS-attended diabetic emergency were socioeconomic status (SIR 0.70 95% CrI [0.51, 0.96]), proportion of overseas-born residents (SIR 2.02 95% CrI [1.37, 2.91]) and motor vehicle access (SIR 1.47 95% CrI [1.08, 1.99]). Recognition of areas of increased risk of prehospital EMS-attended diabetic emergencies may be used to assist prehospital EMS resource planning to meet increased need. In addition, identification of associated factors can be used to target preventative interventions tailored to individual regions to reduce demand.

Hypoglycemia requiring paramedic assistance among adults in southwestern Ontario, Canada: a population-based retrospective cohort study

“…33,34 Age and sex in our study were similar to those in prior reports. [24][25][26][27][28][29]31,32,[34][35][36][37] A high proportion (81.1%) of patients included in our study had documented diabetes, with 42.3% taking insulin, a lower proportion than that found in prior studies 24,25,28,31 with insulin use ranging from 74.0% 31 to 75.9% (type 2 diabetes) and 99.5% (type 1 diabetes). 24 We reported higher glucagon use either alone or in combination (36.9%) than other studies in which use ranged from 0.01% 36 to 17.8%.…”

“…Comparing the frequency of hypoglycemia requiring paramedic assistance between studies is challenging. Prior studies are of shorter duration in varied populations, 16,[24][25][26][27][28][29][30][31][32] with incidence ranging from 4.8 to 103 per 10 000 person-years in Victoria, Australia, 26 to 1150 per 10 000 person-years (type 1 diabetes) and 1180 per 10 000 person-years (type 2 diabetes) in Tayside, Scotland. 16 However, the Tayside study was more than 20 years ago, before the advent of newer insulins with less hypoglycemia risk and advanced glucose monitoring technology.…”

Geographical clustering and socioeconomic factors associated with hypoglycemic events requiring emergency assistance in Andalusia (Spain)

“…To our knowledge, only one report has used spatial and multivariate analyses to understand the geographical clustering and socioeconomic factors associated with hypoglycemic events. 25 Its findings unmasked 21 local government areas with increased risk of hypoglycemia attended by prehospital emergency medical service and also revealed the influence of area-level factors such as the proportion of overseas-born residents and access to a motor vehicle in the state of Victoria in Australia. Other studies have investigated the geographical distribution of diabetes prevalence and cardiac, neurologic, renal and lower extremity diabetic complications, revealing significant clustering in many countries worldwide.…”