Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain.
Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact.



An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012.



Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8.



Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system.
Andalusian Healthcare Emergency Public Service, Neurotraumatologic Hospital.|Department Health Sciences, University of Jaén, Jaén.
R J
RJ
Barranco
Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia.
F
0000-0003-0106-0091
F
Gomez-Peralta
Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia.
C
C
Abreu
Division of Preventive Medicine and Public Health, University of Jaén, Jaén.|Center for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid.
M
M
Delgado-Rodriguez
Endocrinology and Nutrition Unit, City of Jaén Hospital Complex, Jaén.
A
A
Moreno-Carazo
Andalusian Healthcare Emergency Public Service, Neurotraumatologic Hospital.
F
F
Romero
Andalusian Healthcare Emergency Public Service, Los Morales Hospital, Córdoba.
M A
MA
de la Cal
Department of Business Management, Insulcloud S.L., Madrid, Spain.
J M
JM
Barranco
Department of Medicine, Emory University School of Medicine, Atlanta, USA.
F J
FJ
Pasquel
Department of Medicine, Emory University School of Medicine, Atlanta, USA.
G E
GE
Umpierrez
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D004180:Direct Service Costs; D057286:Electronic Health Records; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015994:Incidence; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology