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

Abstract

H ypoglycemia is common in diabetes mellitus. It negatively affects many health-related outcomes. [1][2][3][4][5][6][7][8][9][10] Severe hypoglycemia, that is, hypoglycemia requiring third-party assistance, 11 is a major health concern. The incidence of severe hypoglycemia ranges from 0.8 to 3.2 events per person-year, 10,12-15 and annual prevalence ranges from 10% to 53% for type 1 diabetes 12 and from 4.4% to 6% for type 2 diabetes. 7,13 Severe hypoglycemia is associated with increased cardiovascular events, 1,2 injury 3 and mortality; 1,2,4,5 it impairs quality of life 6,7 and discourages targeting tight glycemic control. 8,9 The economic costs are substantial in terms of the associated use of health care. 16 In Canada, 23% of people who presented to emergency departments with severe hypoglycemia were hospitalized (2008)(2009)(2010). 3 Insulin and oral antihyperglycemic agents were the second and fourth medications, respectively, most frequently associated with emergency hospitalization among adults aged 65 years and older in the United States. 17 Despite serious consequences, it is probable that only some patients with severe hypoglycemia present to hospital, while others are treated only at the scene, by family or friends, or by emergency medical services; thus many episodes are "invisible" to the health care system.