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Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: T he H ypoglycaemia I n P ortugal O bservational S tudy– E mergency R oom ( HIPOS – ER )
Author(s) -
Conceição João,
Dores Jorge,
Araújo Francisco,
Laires Pedro A.,
Carr Richard D.,
Brodovicz Kimberly,
Radican Larry,
Nogueira Ana M.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13030
Subject(s) - medicine , emergency department , observational study , diabetes mellitus , insulin , type 2 diabetes , meal , endocrinology , psychiatry
Aims To analyse the prevalence of severe hypoglycaemia in patients with type 2 diabetes ( T 2 DM ) 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 H ypoglycaemia I n P ortugal O bservational S tudy– E mergency R oom ( 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 ER s 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 T 2 DM 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.