title: Utilisation of emergency medical services for severe hypoglycaemia: An unrecognised health care burden.
abstract: Diabetes is associated with several acute, life-threatening complications yet there are limited data on the utilisation of prehospital services for their management. This study aimed to examine the utilisation of emergency medical services (EMS) for prehospital hypoglycaemia, including patient characteristics and factors related to hospital transportation.
  
  
  
  An observational study of patients requiring EMS for hypoglycaemia across Victoria, Australia over three years was conducted. Pre-specified data including patient demographics, comorbidities, examination findings and transport outcomes were obtained. Logistic regression was used to assess factors associated with transportation.
  
  
  
  During the study period, 12,411 hypoglycaemia events were attended by paramedics for people with diabetes. The majority were individuals with type 1 diabetes (58.8%), followed by type 2 diabetes (35.2%) and unspecified diabetes type (5.9%). Thirty-eight percent of patients were transported to hospital by EMS following hypoglycaemia. Factors associated with transport by EMS included extremes of age (<15 and >75years), female gender, type 2 diabetes, event at a nursing home or hospital/community clinic, presence of comorbidities and time of day.
  
  
  
  Examination of the utilisation of EMS for hypoglycaemia has identified a previously unquantified need for emergency care for people with diabetes as well as factors related to hospital transportation.
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Villani
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Nanayakkara
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia.
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Ranasinha
authors.affiliation: Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia.
authors.forename: Chin Yao
authors.initials: CY
authors.lastname: Tan
authors.affiliation: Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn North, VIC, 3130, Australia; Department of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, 6009.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Monash University School of Primary Health Care, Notting Hill, VIC, 3168; Royal District Nursing Service, RDNS Institute, St Kilda, VIC, 3182.
authors.forename: Amee
authors.initials: A
authors.lastname: Morgans
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia.
authors.forename: Georgia
authors.initials: G
authors.lastname: Soldatos
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.affiliation: Monash Centre for Health Research and Implementation-MCHRI, School Public Health and Preventive Medicine, Monash University in partnership with Monash Health, Locked Bag 29, Clayton, VIC, 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, 3168, Australia; The George Institute for Global Health, Camperdown, NSW, 2050, Australia. Electronic address: sophia.zoungas@monash.edu.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014187:Transportation of Patients; D014739:Victoria
keywords: Diabetes; Diabetic complications; Diabetic emergencies; Emergency Medical Services; Hypoglycaemia; Prehospital