title: Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia.
abstract: OBJECTIVE
  This retrospective chart audit examined the demographics, investigations, management and outcomes of adult patients with diabetes mellitus presenting to Canadian emergency departments (EDs).
  
  
  METHODS
  All sites conducted a search of their electronic medical records using International Classification of Diseases, Tenth Revision, codes to identify ED visits for hypoglycemia between 2008 and 2010. Patient characteristics, demographics, ED management, ED resources and outcome are reported.
  
  
  RESULTS
  A total of 1039 patients over the age of 17 years were included in the study; 347 (33.4%) were classified as type 1 diabetes and 692 (66.6%) were classified as type 2 diabetes. Type 2 diabetes patients were significantly older (73 vs. 49 years; p<0.0001) and had more chronic conditions recorded on their chart (all p<0.001). Most subjects arrived by ambulance, and triage scores revealed severe presentations in 39% of cases. Treatments for hypoglycemia were common (75.7%) during prehospital transport; 38.5% received intravenous glucose and 40.1% received glucagon. Hypoglycemia treatments in the ED included oral (76.8%), intravenous (29.6%) and continuous infusion (27.7%) of glucose. Diagnostic testing (81.9%) commonly included electrocardiograms (51.9%), chest radiography (37.5%) and head computed tomography scans (14.5%). Most patients (73.5%) were discharged; however, more subjects with type 2 diabetes required admission (30.3 vs. 8.8%). Discharge instructions were documented in only 55.5% of patients, and referral to diabetes services occurred in fewer than 20% of cases. Considerable variation existed in the management of hypoglycemia across EDs.
  
  
  CONCLUSIONS
  Patients with diabetes presenting to an ED with hypoglycemia consume considerable healthcare resources, and practice variation exists. Emergency departments should develop protocols for the management of hypoglycemia, with attention to discharge planning to reduce recurrence.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Electronic address: brian.rowe@ualberta.ca.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mira
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Division of Endocrinology and Metabolism, University of Western Ontario, London, Ontario, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Hramiak
authors.affiliation: Division of Emergency Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Edmonds
authors.affiliation: Alberta Health Services and University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Departments of Emergency Medicine and Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Sivilotti
authors.affiliation: Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Scheuermeyer
authors.affiliation: Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: Department of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Riley
authors.affiliation: Emergency Multidisciplinary Research Unit, Jewish General Hospital, McGill University, Montréal, Quebec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Afilalo
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Stiell
authors.affiliation: Division of Endocrinology and Metabolism, McGill University, Montreal, Quebec, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Yale
authors.affiliation: Division of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Woo
authors.affiliation: Departments of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D003920:Diabetes Mellitus / Q000188:drug therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge; D012189:Retrospective Studies; D016896:Treatment Outcome; D014218:Triage
keywords: diabetes mellitus; diabète sucré; emergency department; engorgement; hypoglycemia; hypoglycémie; overcrowding; service des urgences