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Diabetes Metab Res Rev. 2015 Oct;31(7):745-51. doi: 10.1002/dmrr.2667. Epub 2015 Jul 14.

Access to emergency room for hypoglycaemia in people with diabetes.

Author information

1
Department of Clinical and Experimental Medicine - Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy.
2
Department of Emergency - Emergency Medicine Section, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Abstract

BACKGROUND:

Hypoglycaemia is a major burden of the pharmacological therapy of diabetes and is associated with increased morbidity, mortality and treatment costs.

METHODS:

We screened all admissions to the emergency room of the Pisa University Hospital from 1 January 2009 to 31 December 2013, selecting individuals with a discharge diagnosis of hypoglycaemia. We retrieved 500 admissions involving adult diabetic patients: age 71 ± 16 years; M/F 50.2/49.8%; 70.2% type 2 diabetes (T2DM).

RESULTS:

Among T2DM, 42.2% were on insulin, 10.8% on insulin plus oral anti-diabetes drugs and 38.2% on oral anti-diabetes drugs alone (92% sulphonylureas/glinides ± insulin-sensitizers). Glibenclamide was the most frequently used sulphonylurea (69%). Individuals treated with oral anti-diabetes drugs were older than those on insulin (79 ± 11 versus 74 ± 12 years; p < 0.0001). Among patients taking sulphonylurea, 47% had estimated glomerular filtration rate <60 mL/min/1.73 m(2) and 13.5% had <30 mL/min/1.73 m(2) . In-hospital admission occurred in 20% of cases. Hospitalized patients with T2DM were older than those discharged (80 ± 10 versus 76 ± 12 years, p < 0.01) and were on oral antidiabetic drugs in 54.8% of the cases, whereas 35.7% were on insulin (χ(2) , p < 0.0001) and 8.3% on combined therapy. Notably, 93.5% of those on oral anti-diabetic drugs were taking a secretagogue. Insulin-treated subjects were younger than those treated with oral anti-diabetic drugs alone (77 ± 12 versus 82 ± 7 years; p < 0.02). The mean in-hospital annual mortality rate was 85 deaths per 1000 patients-year.

CONCLUSIONS:

Our results support the recommendation that the risk associated with insulin and insulin-secretagogues should be carefully assessed, particularly when prescribed in vulnerable patients with T2DM.

KEYWORDS:

emergency room; hypoglycaemia; sulphonylurea; type 2 diabetes

PMID:
26044573
DOI:
10.1002/dmrr.2667
[Indexed for MEDLINE]

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