The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out-of-hospital therapy.
OBJECTIVE
To determine the short-term medical outcome of hypoglycemic insulin-dependent diabetic patients who refuse transport after out-of-hospital therapy and return to baseline mental status.


METHODS
Prospective, descriptive, short-term medical outcome data for adult patients were collected between May 1996 and December 1996. Paramedics responding to the aid of hypoglycemic insulin-dependent diabetic patients who refused transport after administration of dextrose solution (D50W) contacted a medical command physician at the University of Pennsylvania. The patients' medical histories, names, addresses, and telephone numbers were recorded. Three days after their hypoglycemic episodes, these patients were contacted by telephone by a registered nurse to determine their medical conditions.


RESULTS
Of 132 patients enrolled in the study, 103 (78%) could be contacted by telephone follow-up. Ninety-four (91%) of these patients had no recurrence of symptoms. Nine patients (9%) had recurrence of hypoglycemia and recontacted 911. Eight of these (8%) were transported to a hospital via ambulance and 3 (3%) were admitted, 1 (1%) for a cancer-related illness and 2 (2%) for hypoglycemia, 1 of whom died (1%). The remaining patient refused transport a second time after being treated, despite having the risks of refusal explained to him by a medical command physician.


CONCLUSIONS
The practice of treating and releasing most hypoglycemic insulin-dependent diabetic patients who return to normal mental status after D50W administration appears in general to be safe. Patients should be advised of the risks of recurrent hypoglycemia.
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. mechemc@mail.med.upenn.edu
C C
CC
Mechem
A A
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Kreshak
J
J
Barger
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FS
Shofer
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D004630:Emergencies; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D014187:Transportation of Patients; D016896:Treatment Outcome; D016312:Treatment Refusal
D005947:Glucose