Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources
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Medientyp:
E-Artikel
Titel:
Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources
Beschreibung:
<jats:title>ABSTRACT</jats:title>
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<jats:title>Aim</jats:title>
<jats:p>To triangulate three data sources and report the characteristics and long-term outcomes of patients with diabetes requiring emergency department (ED) care for hypoglycaemia.</jats:p>
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<jats:title>Method</jats:title>
<jats:p>Three data sources were used—ambulance electronic records, hospital episode statistics and patient administration system. Hypoglycaemia (capillary blood glucose &lt;4.0 mmol/L)-related attendances to a single hospital's ED between 1 April 2012 and 31 March 2013 were studied.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>Using the three sources, there were 165 hypoglycaemia-related attendances in 132 patients with diabetes [type 1–59 episodes in 43 patients, type 2–106 episodes in 89 patients (therapy—54 (51%) insulin, 35 (33%) sulfonylurea, 11 (10%) both, 6 (6%) others)]. At best only 65% of episodes would have been identified were a single data source used. Patients with type 2 vs type 1 diabetes were older (median age 79 vs 61 years, p&lt;0.0001), had more comorbidities (median Charlson comorbidity index (CCI) 4 vs 3, p=0.002) but no difference in HbA1c (median 7.8% vs 8.4%, p=0.065). Compared with insulin-treated type 2 patients with diabetes, sulfonylurea-treated patients (33%) were older (median age 82 vs 76 years, p=0.007), had worse renal function (median estimated glomerular filtration rate 38 vs 56 mL/min/1.73 m2, p=0.019) and lower HbA1c (median 6.7% vs 8.4%, p&lt;0.0001). At least 17 (10%) hypoglycaemic episodes resulted in additional serious harm. The 30-day, 90-day and 1-year all-cause mortality were 10.6% (14), 16.7% (22) and 28% (37), respectively. Age, CCI and hospitalisation were risk factors for long-term mortality.</jats:p>
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<jats:title>Conclusions</jats:title>
<jats:p>Dependence on a single data source would have at best identified only 65% of episodes. One-third of episodes were sulfonylurea related in patients with type 2 diabetes, and one-fourth of all patients with diabetes who required ED care for hypoglycaemia died the following year.</jats:p>
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