Access to emergency room for hypoglycaemia in people with diabetes. Issue 7 (14th July 2015)

• Record Type: Journal Article
• Authors: Salutini, Elisabetta; Bianchi, Cristina; Santini, Massimo; Dardano, Angela; Daniele, Giuseppe; Penno, Giuseppe; Miccoli, Roberto; Del Prato, Stefano
• Is Part Of: Diabetes/metabolism research and reviews. Volume 31:Issue 7(2015:Oct.)
• Page Start: 745
• Page End: 751
• Publication Date: 2015-07-14
• Subjects: Diabetes -- Periodicals; Metabolism -- Periodicals; 616.642
• DOI: 10.1002/dmrr.2667
• Languages: English
• ISSNs: 1520-7552

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="dmrr2667-sec-0001" sec-type="section"> <title>Background</title> <p>Hypoglycaemia is a major burden of the pharmacological therapy of diabetes and is associated with increased morbidity, mortality and treatment costs.</p> </sec> <sec id="dmrr2667-sec-0002" sec-type="section"> <title>Methods</title> <p>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).</p> </sec> <sec id="dmrr2667-sec-0003" sec-type="section"> <title>Results</title> <p>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 <italic>versus</italic> 74 ± 12 years; <italic>p</italic> < 0.0001). Among patients taking sulphonylurea, 47% had estimated glomerular filtration rate <60 mL/min/1.73 m<sup>2</sup> and 13.5% had <30 mL/min/1.73 m<sup>2</sup>. In‐hospital admission occurred in 20% of cases. Hospitalized patients with T2DM were older than those discharged (80 ± 10 <italic>versus</italic> 76 ± 12 years, <italic>p</italic> < 0.01) and were on oral antidiabetic drugs in 54.8% of the cases, whereas 35.7% were on insulin (<italic>χ</italic><sup>2</sup>, <italic>p</italic> < 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 <italic>versus</italic> 82 ± 7 years; <italic>p</italic> < 0.02). The mean in‐hospital annual mortality rate was 85 deaths per 1000 patients‐year.</p> </sec> <sec id="dmrr2667-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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. Copyright © 2015 John Wiley & Sons, Ltd.</p> </sec> </abstract>