title: The management of severe hypoglycemia by the emergency system: the HYPOTHESIS study.
abstract: OBJECTIVE
  Severe hypoglycemia is not rare in diabetes and markedly impacts on health resource use. We aimed to describe the characteristics of patients attending emergency departments (EDs) following a severe episode of hypoglycemia, the factors associated with the management of events and the final outcome.
  
  
  RESULTS
  We carried out a retrospective analysis of cases attending 46 Italian EDs for hypoglycemia from January 2011 to June 2012. A total of 3753 records were retrieved from the databases of the participating centers, part of a network repeatedly involved in collaborative studies; 3516 episodes occurred in subjects with diabetes (median age, 76 years; range, 1-102). Comorbidities were recorded in 2320 (65.9%) diabetes cases; association with trauma or road accidents in 287 (8.2%) and 47 (1.3%), respectively. Patients were treated with insulin (49.8%), oral agents (31.4%), or combination treatment (15.1%). The event required assistance by the out-of-hospital Emergency services in 1821 cases (51.8%). Following the ED visit, admission to hospital departments was deemed necessary in 1161 cases (33.1%). Diabetes treatment (oral agents: OR, 1.63; 95% confidence interval (CI), 1.37-1.94), increasing age (OR, 1.39; 95% CI, 1.31-1.48) and the number of comorbidities (OR, 1.51; 95% CI, 1.38-1.66) were the main drivers of admission. The in-hospital death rate was 10%, associated with the number of comorbidities (OR, 1.28; 95%CI, 1.01-1.63).
  
  
  CONCLUSIONS
  Severe hypoglycemia requiring referral to EDs is associated with a significant work-up of the Emergency services and a remarkable in-hospital death rate in frail individuals with diabetes.
authors.affiliation: Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy. Electronic address: giulio.marchesini@unibo.it.
authors.forename: G
authors.initials: G
authors.lastname: Marchesini
authors.affiliation: Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Veronese
authors.affiliation: Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Forlani
authors.affiliation: Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Forlani
authors.affiliation: Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy.
authors.forename: L M
authors.initials: LM
authors.lastname: Ricciardi
authors.affiliation: Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Via Forlanini 34, I-47121 Forlì, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fabbri
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People
chemical_list: D007328:Insulin
keywords: Diabetes; Emergency services; Hypoglycemia; Hypoglycemic agents