title: Hypoglycemia requiring ambulance services in patients with type 2 diabetes is associated with increased long-term mortality.
abstract: OBJECTIVE
  To report population burden of hypoglycemia requiring ambulance services and long term outcomes thereafter, among people with type 2 diabetes (T2D).
  
  
  METHODS
  We retrieved all ambulance calls made by T2D for hypoglycemia in Olmsted County, Minnesota, between January 1, 2003, and December 31, 2009.
  
  
  RESULTS
  Seven hundred eighteen calls were made by 503 T2D (age 69 ± 12 years, 51% male), of which 328 (65%) were on insulin (INS), 54 (11%) on insulin + noninsulin agents (NIAI), 95 (19%) on sulphonylurea alone or in combination with other noninsulin agents (SFU), 21 (4%) on nonsulphonylurea noninsulin agents (NSFU), and 5 (1%) on no therapy (excluded from further analysis). NSFU had lower repeated calls (INS 25%, NIAI 26%, SFU 12%, NSFU 5%; P = .02), emergency room transportation (ERT) (INS 62%, NIAI 67%, SFU 68%, NSFU 38%; P = .06), and hospitalizations (INS 31%, NIAI 46%, SFU 38%, NSFU 19%; P = .02) compared to other groups. In multivariable mortality model, increased age (P<.001) was associated with an increased risk of death, whereas hypoglycemia predisposing comorbidities (chronic liver disease, end stage renal disease, adrenal insufficiency) (P = .06) were associated with a borderline increased risk, but no association was found with treatment group, repeated calls, ERT, hospitalization and baseline diabetic end organ complications.
  
  
  CONCLUSIONS
  To our knowledge, we report the first estimate of hypoglycemia requiring ambulance services among T2D, in contemporary clinical practice. NSFU cohort was associated with lower repeated calls, ERT, and hospitalizations compared to other therapeutic programs. Predictors of mortality post-hypoglycemia were age and hypoglycemia predisposing comorbidities.
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN 55902, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Parsaik
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Myers
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
authors.forename: Yogish C
authors.initials: YC
authors.lastname: Kudva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000401:mortality*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012306:Risk
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin