title: Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: a retrospective study.
abstract: OBJECTIVE
  To report the characteristics and treatment of individuals requiring emergency ambulance services for severe hypoglycaemia and estimate associated provider costs.
  
  
  METHODS
  Retrospective analysis of routinely collected data collected by the East Midlands Ambulance Trust, UK, of episodes of severe hypoglycaemia attended by emergency ambulance services during a four-month period. Standard clinical measures, response time, on-site treatment and transportation were recorded and ambulance services costs calculated.
  
  
  RESULTS
  90,435 emergency calls were recorded, 523 (0.6%) for severe hypoglycaemia, equating to an incidence of to 2.76 per 100 patient years; 74% of individuals were insulin-treated, 28% of events occurred nocturnally (00:00-07:59), and 32% were transported to hospital. Higher respiratory rate was a positive predictor (p=0.03), whereas higher post treatment blood glucose (p=0.05) and insulin treatment (p<0.01) were negative predictors of transport to hospital. Median treatment costs for individuals transported and not transported to hospital were £92 and £176 respectively.
  
  
  CONCLUSIONS
  Most cases of severe hypoglycaemia requiring assistance from emergency ambulance services are successfully treated at the scene. Individuals not responding to treatment or were non insulin-treated were more likely to be transported to hospital. Further studies are needed to evaluate the effect of prehospital ambulance care by treatment and diabetes type on subsequent outcomes.
authors: Department of Health Sciences, University of Leicester, Leicester Diabetes Centre, Gwendolen Road, Leicester LE5 4PW, UK. kk22@leicester.ac.uk
authors: Kamlesh
authors: K
authors: Khunti
authors: Harriet
authors: H
authors: Fisher
authors: Sanjoy
authors: S
authors: Paul
authors: Mohammad
authors: M
authors: Iqbal
authors: Melanie J
authors: MJ
authors: Davies
authors: A Niroshan
authors: AN
authors: Siriwardena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000191:economics; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D004632:Emergency Medical Services / Q000191:economics; D004739:England; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007328:Insulin / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin