title: Severe hypoglycemia is a serious complication and becoming an economic burden in diabetes.
abstract: BACKGROUND
  The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.
  
  
  METHODS
  The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.
  
  
  RESULTS
  Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m(2). In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.
  
  
  CONCLUSIONS
  Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Ha
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Oh
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Sang Ah
authors.initials: SA
authors.lastname: Chang
authors.forename: Tae Seo
authors.initials: TS
authors.lastname: Sohn
authors.forename: Hyun Shik
authors.initials: HS
authors.lastname: Son