Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: The Hypoglycaemia In Portugal Observational Study–Emergency Room (HIPOS–ER). Issue 1 (31st July 2017)

• Record Type: Journal Article
• Authors: Conceição, João; Dores, Jorge; Araújo, Francisco; Laires, Pedro A.; Carr, Richard D.; Brodovicz, Kimberly; Radican, Larry; Nogueira, Ana M.
• Is Part Of: Diabetes, obesity & metabolism. Volume 20:Issue 1(2018)
• Page Start: 50
• Page End: 59
• Publication Date: 2017-07-31
• Subjects: hypoglycaemia -- type 2 diabetes -- emergency department; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.13030
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract : Aims: To analyse the prevalence of severe hypoglycaemia in patients with type 2 diabetes (T2DM) treated with antihyperglycaemic agents (AHA) and requiring emergency room (ER) assistance, and to analyse the prevalence according to type of AHA therapy. Methods: The present study, the Hypoglycaemia In Portugal Observational Study–Emergency Room (HIPOS–ER), was a cross‐sectional, observational, multicentre, nationwide study, with specific hypoglycaemia source data collection. Results: Within the study period, a total of 425 706 admissions were recorded in the ERs of participating hospitals. The prevalence of severe hypoglycaemic episodes in patients with T2DM was 0.074%. In all, 238 patients were included, more than half of whom were on insulin‐based therapy (55.0%) and a third of whom (31.5%) were on oral secretagogue‐based therapy. In 61.2% of patients primary care was the main diabetes care setting. The median patient age was 77.5 years and the mean duration of diabetes was 19 years. Missing a meal or low carbohydrate meal content was the most frequent cause of hypoglycaemia (55.9%) and the most frequent triggers for seeking emergency assistance were pre‐syncope (19.2%) and transient loss of consciousness (17.4%). A total of 44.1% of patients were hospitalized for a median of 5.1 days. Patients in the secretagogue group were admitted to hospital more often than patients in the insulin group (70.7% vs 29.0%; P < .001). Nine patients died. Conclusions: These findings confirm that severe hypoglycaemia in patients with T2DM requiring ER assistance occurs mainly in those on insulin‐ and secretagogue‐based therapies and is associated with a significant medical burden. Antidiabetic therapy should be individualized to minimize the risk of severe iatrogenic hypoglycaemia, and any intervention to this end should always involve primary care stakeholders.