title: Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources.
abstract: OBJECTIVE
  To triangulate three data sources and report the characteristics and long-term outcomes of patients with diabetes requiring emergency department (ED) care for hypoglycaemia.
  
  
  METHODS
  Three data sources were used-ambulance electronic records, hospital episode statistics and patient administration system. Hypoglycaemia (capillary blood glucose <4.0 mmol/L)-related attendances to a single hospital's ED between 1 April 2012 and 31 March 2013 were studied.
  
  
  RESULTS
  Using the three sources, there were 165 hypoglycaemia-related attendances in 132 patients with diabetes [type 1-59 episodes in 43 patients, type 2-106 episodes in 89 patients (therapy-54 (51%) insulin, 35 (33%) sulfonylurea, 11 (10%) both, 6 (6%) others)]. At best only 65% of episodes would have been identified were a single data source used. Patients with type 2 vs type 1 diabetes were older (median age 79 vs 61 years, p<0.0001), had more comorbidities (median Charlson comorbidity index (CCI) 4 vs 3, p=0.002) but no difference in HbA1c (median 7.8% vs 8.4%, p=0.065). Compared with insulin-treated type 2 patients with diabetes, sulfonylurea-treated patients (33%) were older (median age 82 vs 76 years, p=0.007), had worse renal function (median estimated glomerular filtration rate 38 vs 56 mL/min/1.73 m(2), p=0.019) and lower HbA1c (median 6.7% vs 8.4%, p<0.0001). At least 17 (10%) hypoglycaemic episodes resulted in additional serious harm. The 30-day, 90-day and 1-year all-cause mortality were 10.6% (14), 16.7% (22) and 28% (37), respectively. Age, CCI and hospitalisation were risk factors for long-term mortality.
  
  
  CONCLUSIONS
  Dependence on a single data source would have at best identified only 65% of episodes. One-third of episodes were sulfonylurea related in patients with type 2 diabetes, and one-fourth of all patients with diabetes who required ED care for hypoglycaemia died the following year.
authors.affiliation: Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajendran
authors.affiliation: Accident and Emergency Department, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hodgkinson
authors.affiliation: Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: Rayman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000379:methods; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
keywords: ACCIDENT & EMERGENCY MEDICINE; DIABETES & ENDOCRINOLOGY; ambulance; hypoglycaemia; mortality