Outcomes of community-dwelling adults without diabetes mellitus who require ambulance services for hypoglycemia.
OBJECTIVE
We evaluate the prevalence, etiology, and outcomes of hypoglycemia requiring emergency medical services (EMS) in patients without diabetes mellitus (non-DM).


METHODS
We reviewed medical records of all ambulance calls for non-DM with blood glucose <70 mg/dl in Olmsted County, Minnesota, between January 1, 2003, and December 31, 2009.


RESULTS
A total of 131 patients (age 51 ± 19 years; 54 % females) made 142 EMS calls, while 10 patients made repeated calls. Causes of hypoglycemia were critical illness (42; 32%), alcohol and polysubstance use (36; 27.5 %), insulinoma/bariatric surgery (10; 8%), restricted oral intake (7; 5%), and multiple factors (3; 27.5 %). Patients with alcohol and polysubstance abuse were younger (p = .002). A total of 54 patients had additional hypoglycemia predisposing comorbidities/factors [adrenal insufficiency (2), end-stage renal disease (11) and chronic liver disease (7), beta blockers use (34), and pentamidine use (1)]. Repeated calls and emergency room transportation were similar, but hospitalization varied across the etiologies, with the lowest proportion in the multiple-factor-related hypoglycemia group (p = .01). Duration of follow-up was 1.28 (interquartile range 0.13-2.70) years. A total of 38 patients died, and age-adjusted mortality varied across different etiologies (p < .001), with highest among critically ill. Cancer caused the highest number of deaths (7/38; 18%), while 1 death was due to hypoglycemia.


CONCLUSIONS
There were multiple etiologies for hypoglycemic episodes in community-dwelling non-DM that required EMS. Critical illness, multifactorial causes, and alcohol/polysubstance abuse were common causes. Hospitalization and mortality were higher with critical illnesses.
Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Ajay K
AK
Parsaik
Rickey E
RE
Carter
Lucas A
LA
Myers
Ming
M
Dong
Ananda
A
Basu
Yogish C
YC
Kudva
D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome