Frequency of Severe Hypoglycemia Requiring Emergency Treatment in Type 1 and Type 2 Diabetes
A population-based study of health service resource use
- Graham P. Leese, MD12,
- Jixian Wang, PHD2,
- Janice Broomhall, BSC2,
- Paul Kelly3,
- Andrew Marsden3,
- William Morrison, MB4,
- Brian M. Frier, MD5,
- Andrew D. Morris, MD12 and
- For the DARTS/MEMO Collaboration
- 1Department of Medicine, Ninewells Hospital and Medical School, Dundee, U.K.
- 2Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, U.K.
- 3Scottish Ambulance Service, Tayside Division, Dundee, U.K.
- 4Accident and Emergency Department, Ninewells Hospital and Medical School, Dundee, U.K.
- 5Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, U.K.
OBJECTIVE—To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes.
RESEARCH DESIGN AND METHODS—Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated.
RESULTS—A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identified as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was ≤£92,078 in one year.
CONCLUSIONS—Hypoglycemia requiring emergency assistance from health service personnel is as common in people with type 2 diabetes treated with insulin as in people with type 1 diabetes. It is associated with considerable NHS resource use that has a significant economic and personal cost.
Address correspondence and reprint requests to Graham P. Leese, Ward 1 and 2, Ninewells Hospital, Dundee, DD1 9SY, U.K. E-mail:.
Received for publication 26 August 2002 and accepted in revised form 10 January 2003.
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- DIABETES CARE