Population-Based Study of Severe Hypoglycemia Requiring Emergency Medical Service Assistance Reveals Unique Findings

Parsaik, Ajay K.; Carter, Rickey E.; Pattan, Vishwanath; Myers, Lucas A.; Kumar, Hamit; Smith, Steven A.; Russi, Christopher S.; Levine, James A.; Basu, Ananda; Kudva, Yogish C.

doi:10.1177/193229681200600109

Cited by 31 publications

(20 citation statements)

References 22 publications

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“…This study also supplements the finding of significant long-term mortality in patients with diabetes requiring emergency care reported in a similar study from the USA 16 17. The 1-year mortality seen in this study was comparable to that reported 16 17.…”

Section: Discussionsupporting

confidence: 89%

“…The 1-year mortality seen in this study was comparable to that reported 16 17. Additionally in that study, age and comorbidities were predictors of long-term mortality as in this study, but in contrast hospitalisation was not.…”

Section: Discussionsupporting

confidence: 82%

“…Sulfonylurea-induced hospitalisation in the elderly is now increasingly recognised as a problem worldwide 14 15. A recent population-based study from a single county in the USA demonstrated significant long-term mortality in patients with type 2 diabetes who required emergency medical services for hypoglycaemia 16 17. Similar long-term mortality data are lacking in the UK.…”

Section: Introductionmentioning

confidence: 99%

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Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Rajendran

Hodgkinson

Rayman

2015

Postgraduate Medical Journal

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Rajendran

Hodgkinson

Rayman

2015

Postgraduate Medical Journal

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“…The transported patient was more in Un-Saudi, therefore maybe Saudi depend on transportation by they're on cars.However, protocol insists on transporting all the patient.A condition like hypoglycemia, the patient should be transferred to get suitable care, maybe EMS don't know the consequences for not transfer hypoglycemia patient where most of EMS have a diploma.In Germany,The Nontransported patient with type 1 diabetes increased from 8% to 25%. 6,13 In West Hampshire, UK, paramedics were trained to direct the majority of diabetes patients with hypoglycemia to community diabetes services and patients were taken to the ED only when "necessary;" after the introduction of the protocol, 23% of 291 patients experiencing a hypoglycemic episode were referred to the community diabetes specialist team, and non-transport to hospital increased from 12% to 40% of patients.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemic Patient Transported by EMS inMakkah Region, 2017

Shammah

Mohammad

Helmi

et al. 2018

IJND

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Objective:To estimate the incident rate of the hypoglycemic patients transported by EMS and to evaluate EMS primary impression for these patients. Methods and Design: Retrospective, observational study was based on data for 150,563 SAUDI RED CRESENT AUTHORITY Transported Patients during 2017. Subjects were defined as having Hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dL Or "unspecified low"). The outcome of interest was patient transport or non-transport to an emergency department or other care settings. Results:Among 150,563 eligible encounters, 1984(1.29%) were diagnosed with hypoglycemia, of which 536 (27%) were not transported. Nontransported was more likely among male adult patients age (40-59), initial blood glucose <60 mg/dl or EMS arrival time midnight -6 A.M. Conclusion: A low rate of the non-transported patient to ED, Imperfect agreement between a primary impression of hypoglycemia and documented low blood glucose.

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“…However, hypoglycaemia is frequently also observed in patients without diabetes [1]. Hypoglycaemia in patients without diabetes has been supposed to be associated with a high mortality rate [2, 3]. In hospitalized patients without diabetes, the risk of developing hypoglycaemia is associated with malnutrition, malignancy, renal disease, congestive heart failure, and sepsis [4].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study

Vihonen

Kuisma

Nurmi

2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe current study investigates the incidence, aetiology, and outcome of hypoglycaemia of patients without diabetes in the EMS.MethodsThe study was a retrospective cohort study that utilized electronic EMS patient record system (population of one million). All patients encountered by EMS with plasma glucose ≤3.9 mmol/l from 2009 to 2015 were included in the study and hospital records were screened manually to detect possible reasons for hypoglycaemia. Data from the governmental health insurance agency for all residents in Finland was used to reveal the diabetes status of the patients. Survival of the patients was followed from Population register centre up to six years. Serious hypoglycaemia was defined as plasma glucose ≤3.0 mmol/l.ResultsFrom EMS cases with a plasma glucose measurement a total of 5467 hypoglycaemic patients without diabetes were encountered by EMS during the study period with an incidence of 1082 (CI95% 1019–1148) per 100,000 inhabitants per year, corresponding 41.6%, (CI95% 40.8–42.3) of all hypoglycaemic patients. Of those patients, 3856 [71.6%, (CI95% 70.4–72.8)] were transported to hospital and 910 [23.2%, (CI95% 22.0–24.6)] had serious hypoglycaemia. The three main diagnosis groups that appeared in the subsequent hospital treatment associated with hypoglycaemia in all transported cases without diabetes as well with serious hypoglycaemia cases were: alcohol abuse [41.2%, (CI95% 39.7–42.8) and 42.2%, (CI95% 39.0–45.4)], hypothermia [17.2%, (CI95% 16.0–18.4) and 27.4%, (CI95% 24.6–30.4)], and malnutrition [16.9%, (CI95% 15.8–18.1) and 25.1%, (CI95% 22.4–28.0)]. Mortality ranged from 0.6–65.4% depending of admission reason and increased significantly at long-term. Non-Diabetics survival was less than with diabetics, when serious hypoglycaemia was present.DiscussionThe most common possible hypoglycaemia related aetiological causes encountered in the EMS, alcohol abuse, hypothermia, and malnutrition, although frequent are often relatively benign conditions. These possible causes of hypoglycaemia can often be treated at scene or need only short hospital admissions. Hence they are not so prevalent in hospital studies.ConclusionsHypoglycaemia without diabetes is commonly observed among the hypoglycaemic EMS cases. Main causes for it are alcohol abuse, hypothermia, and malnutrition. Mortality correlated with age, higher priority dispatch codes, and plasma glucose rate in multivariate logistic regression analysis. Some of the etiological subgroups carry a markedly high mortality rate.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0480-7) contains supplementary material, which is available to authorized users.

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Population-Based Study of Severe Hypoglycemia Requiring Emergency Medical Service Assistance Reveals Unique Findings

Cited by 31 publications

References 22 publications

Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources

Hypoglycemic Patient Transported by EMS inMakkah Region, 2017

Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study

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