title: Hypoglycaemia requiring medical assistance in patients with diabetes: a prospective multicentre survey in tertiary hospitals.
abstract: OBJECTIVE
  Hypoglycaemia is considered a factor contributing to morbidity and mortality in patients with diabetes. The aim of the present study was to examine the frequency, clinical characteristics, predisposing factors and outcomes of iatrogenic hypoglycaemia requiring medical assistance.
  
  
  METHODS
  Eight hospitals participated in this prospective survey of documented iatrogenic hypoglycaemia at their emergency departments. Cases with type 2 diabetes (T2D) were compared with a control group, consisting of patients visiting the outpatients' diabetes clinics of the same hospitals during the same time period.
  
  
  RESULTS
  Median survey duration was 16.5 months, and 295 episodes of iatrogenic hypoglycaemia were recorded. Frequency varied across centres from 0.25 to 0.78 cases per 100 presenting patients. Most cases (90.8%) were observed in patients with T2D (mean age: 76.7±10.1 years), while 8.1% of events were recorded in patients with type 1 diabetes (mean age: 42.7±18.3 years). Total in-hospital mortality was 3.4%, and all involved patients with T2D. In T2D patients, advanced age (OR: 1.3 [1.20-1.45] for 5-year increase), use of sulphonylureas (OR: 4.0 [2.5-6.36]), use of insulin (OR: 2.35 [1.42-3.95]), lower estimated GFR (OR: 1.15 [1.07-1.23] at 10mL/min) and number of comorbidities (OR: 1.74 [1.34-2.27]) were each independently associated with hypoglycaemia requiring medical assistance.
  
  
  CONCLUSIONS
  Hypoglycaemia requiring medical assistance in patients with diabetes is a moderately common condition seen in emergency departments and has a mortality rate of 3.4%. The majority of cases involve elderly individuals with T2D who are suffering from serious comorbidities and treated with insulin and/or sulphonylureas.
authors.affiliation: First Department of Internal Medicine, Diabetes Centre, Athens University Medical School, Laiko Hospital, Athens, Greece. Electronic address: s.liatis@yahoo.com.
authors.forename: S
authors.initials: S
authors.lastname: Liatis
authors.affiliation: First Department of Internal Medicine, Diabetes Centre, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Mylona
authors.affiliation: Department of Internal Medicine, General Hospital of Lamia, Lamia, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Kalopita
authors.affiliation: Third Department of Internal Medicine and Diabetes Centre, Nikaia General Hospital, Piraeus, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Papazafiropoulou
authors.affiliation: Department of Internal Medicine, General Hospital of Larissa, Larissa, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Karamagkiolis
authors.affiliation: Diabetes Centre, Tzaneio Hospital, Piraeus, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Melidonis
authors.affiliation: Department of Internal Medicine, General Hospital of Agrinio, Agrinio, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Xilomenos
authors.affiliation: Diabetes Centre, Department of Internal Medicine, Konstantopouleio Hospital, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Ioannidis
authors.affiliation: Endocrinology Unit, Department of Pathophysiology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kaltsas
authors.affiliation: Department of Internal Medicine, General Hospital of Lamia, Lamia, Greece.
authors.forename: L
authors.initials: L
authors.lastname: Lanaras
authors.affiliation: Third Department of Internal Medicine and Diabetes Centre, Nikaia General Hospital, Piraeus, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Papas
authors.affiliation: First Department of Internal Medicine, Diabetes Centre, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Basagiannis
authors.affiliation: First Department of Internal Medicine, Diabetes Centre, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Kokkinos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
keywords: Hypoglycaemia; Type 1 diabetes; Type 2 diabetes