Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia

Brian H Rowe; Mira Singh; Cristina Villa-Roel; Lawrence A Leiter; Irene Hramiak; Marcia L Edmonds; Eddy Lang; Marco Sivilotti; Frank Scheuermeyer; Andrew Worster; Jennifer Riley; Marc Afilalo; Ian Stiell; Jean-Francois Yale; Vincent C Woo; Samuel Campbell; Canadian Association of Emergency Physicians Research Consortium

doi:10.1016/j.jcjd.2014.04.001

Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia

Can J Diabetes. 2015 Feb;39(1):55-64. doi: 10.1016/j.jcjd.2014.04.001. Epub 2014 Aug 29.

Authors

Brian H Rowe¹, Mira Singh², Cristina Villa-Roel³, Lawrence A Leiter⁴, Irene Hramiak⁵, Marcia L Edmonds⁶, Eddy Lang⁷, Marco Sivilotti⁸, Frank Scheuermeyer⁹, Andrew Worster¹⁰, Jennifer Riley¹¹, Marc Afilalo¹², Ian Stiell¹³, Jean-Francois Yale¹⁴, Vincent C Woo¹⁵, Samuel Campbell¹⁶; Canadian Association of Emergency Physicians Research Consortium

Affiliations

¹ Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
² Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
³ Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
⁴ Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Endocrinology and Metabolism, University of Western Ontario, London, Ontario, Canada.
⁶ Division of Emergency Medicine, University of Western Ontario, London, Ontario, Canada.
⁷ Alberta Health Services and University of Calgary, Calgary, Alberta, Canada.
⁸ Departments of Emergency Medicine and Pharmacology and Toxicology, Queen's University, Kingston, Ontario, Canada.
⁹ Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
¹⁰ Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
¹¹ Department of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Emergency Multidisciplinary Research Unit, Jewish General Hospital, McGill University, Montréal, Quebec, Canada.
¹³ Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Division of Endocrinology and Metabolism, McGill University, Montreal, Quebec, Canada.
¹⁵ Division of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁶ Departments of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada.

PMID: 25175314
DOI: 10.1016/j.jcjd.2014.04.001

Abstract

Objectives: 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.

Keywords: diabetes mellitus; diabète sucré; emergency department; engorgement; hypoglycemia; hypoglycémie; overcrowding; service des urgences.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Canada
Diabetes Mellitus / drug therapy*
Disease Management*
Emergency Service, Hospital*
Female
Humans
Hypoglycemia / drug therapy*
Male
Middle Aged
Patient Admission / statistics & numerical data
Patient Discharge
Retrospective Studies
Treatment Outcome
Triage