title: National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations.
abstract: OBJECTIVE
  Detailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets.
  
  
  OBJECTIVE
  To describe the US burden, rates, and characteristics of emergency department (ED) visits and emergency hospitalizations for IHEs.
  
  
  METHODS
  Nationally representative public health surveillance of adverse drug events among insulin-treated patients seeking ED care (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project) and a national household survey of insulin use (the National Health Interview Survey) were used to obtain data from January 1, 2007, through December 31, 2011.
  
  
  METHODS
  Estimated annual numbers and estimated annual rates of ED visits and hospitalizations for IHEs among insulin-treated patients with diabetes mellitus.
  
  
  RESULTS
  Based on 8100 National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance cases, an estimated 97,648 (95% CI, 64,410-130,887) ED visits for IHEs occurred annually; almost one-third (29.3%; 95% CI, 21.8%-36.8%) resulted in hospitalization. Severe neurologic sequelae were documented in an estimated 60.6% (95% CI, 51.3%-69.9%) of ED visits for IHEs, and blood glucose levels of 50 mg/dL (to convert to millimoles per liter, multiply by 0.0555) or less were recorded in more than half of cases (53.4%). Insulin-treated patients 80 years or older were more than twice as likely to visit the ED (rate ratio, 2.5; 95% CI, 1.5-4.3) and nearly 5 times as likely to be subsequently hospitalized (rate ratio, 4.9; 95% CI, 2.6-9.1) for IHEs than those 45 to 64 years. The most commonly identified IHE precipitants were reduced food intake and administration of the wrong insulin product.
  
  
  CONCLUSIONS
  Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Geller
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehab
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Maribeth C
authors.initials: MC
authors.lastname: Lovegrove
authors.affiliation: Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Kegler
authors.affiliation: SRA International, Atlanta, Georgia.
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Weidenbach
authors.affiliation: College of Pharmacy and Health Sciences, Mercer University, Atlanta, Georgia.
authors.forename: Gina J
authors.initials: GJ
authors.lastname: Ryan
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Budnitz
mesh_terms: D000367:Age Factors; D003625:Data Collection; D003920:Diabetes Mellitus / Q000188:drug therapy; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D008508:Medication Errors / Q000191:economics / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin