The management of severe hypoglycemia by the emergency system: The HYPOTHESIS study

•We reviewed diabetes cases attending 46 emergency departments for hypoglycemia.•Insulin, either alone or in combination, was involved in nearly two-thirds of cases.•Increasing age, oral glucose-lowering agents and comorbidities were associated with admission.•In-hospital mortality was very high, also driven by the number of comorbidities.•Severe hypoglycemia carries a risk of adverse outcomes in elderly and frail subjects.

Background and aimsSevere hypoglycemia is not rare in diabetes and markedly impacts on health resource use. We aimed to describe the characteristics of patients attending emergency departments (EDs) following a severe episode of hypoglycemia, the factors associated with the management of events and the final outcome.Methods and resultsWe carried out a retrospective analysis of cases attending 46 Italian EDs for hypoglycemia from January 2011 to June 2012. A total of 3753 records were retrieved from the databases of the participating centers, part of a network repeatedly involved in collaborative studies; 3516 episodes occurred in subjects with diabetes (median age, 76 years; range, 1–102). Comorbidities were recorded in 2320 (65.9%) diabetes cases; association with trauma or road accidents in 287 (8.2%) and 47 (1.3%), respectively. Patients were treated with insulin (49.8%), oral agents (31.4%), or combination treatment (15.1%). The event required assistance by the out-of-hospital Emergency services in 1821 cases (51.8%). Following the ED visit, admission to hospital departments was deemed necessary in 1161 cases (33.1%). Diabetes treatment (oral agents: OR, 1.63; 95% confidence interval (CI), 1.37–1.94), increasing age (OR, 1.39; 95% CI, 1.31–1.48) and the number of comorbidities (OR, 1.51; 95% CI, 1.38–1.66) were the main drivers of admission. The in-hospital death rate was 10%, associated with the number of comorbidities (OR, 1.28; 95%CI, 1.01–1.63).ConclusionSevere hypoglycemia requiring referral to EDs is associated with a significant work-up of the Emergency services and a remarkable in-hospital death rate in frail individuals with diabetes.