Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: The Hypoglycaemia In Portugal Observational Study–Emergency Room (HIPOS–ER)

Abstract

Aims: To analyse the prevalence of severe hypoglycaemia in patients with type 2 diabetes (T2DM) treated with antihyperglycaemic agents (AHA) and requiring emergency room (ER) assistance, and to analyse the prevalence according to type of AHA therapy.Methods: The present study, the Hypoglycaemia In Portugal Observational Study-Emergency Room (HIPOS-ER), was a cross-sectional, observational, multicentre, nationwide study, with specific hypoglycaemia source data collection.Results: Within the study period, a total of 425 706 admissions were recorded in the ERs of participating hospitals. The prevalence of severe hypoglycaemic episodes in patients with T2DM was 0.074%. In all, 238 patients were included, more than half of whom were on insulin-based therapy (55.0%) and a third of whom (31.5%) were on oral secretagogue-based therapy. In 61.2% of patients primary care was the main diabetes care setting. The median patient age was 77.5 years and the mean duration of diabetes was 19 years. Missing a meal or low carbohydrate meal content was the most frequent cause of hypoglycaemia (55.9%) and the most frequent triggers for seeking emergency assistance were pre-syncope (19.2%) and transient loss of consciousness (17.4%). A total of 44.1% of patients were hospitalized for a median of 5.1 days. Patients in the secretagogue group were admitted to hospital more often than patients in the insulin group (70.7% vs 29.0%; P < .001). Nine patients died.Conclusions: These findings confirm that severe hypoglycaemia in patients with T2DM requiring ER assistance occurs mainly in those on insulin-and secretagogue-based therapies and is associated with a significant medical burden. Antidiabetic therapy should be individualized to minimize the risk of severe iatrogenic hypoglycaemia, and any intervention to this end should always involve primary care stakeholders. K E Y W O R D Shypoglycaemia, type 2 diabetes, emergency department

Risk factors and outcomes of severe hypoglycaemia requiring hospital admission: a retrospective study

“…One meta‐analysis showed that severe hypoglycaemia requiring hospital admission was recorded in only 6.7% of all hypoglycaemic episodes 8 . Similarly, the Hypoglycaemia in Portugal Observational Study–Emergency Room (HIPOS–ER), a nationwide observational study of patients with T2DM and hypoglycaemia in the emergency department, showed that 44% of 238 patients required hospital admission 9 . This reflects the variation in management strategies among different clinical settings.…”

Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach

“…Absenteeism was considered from ER admission, hospital and home stay post-discharge for both patients and caregivers, as patients with DM are mostly retired and require the assistance of family members [ 17 , 18 ].…”

“…HypoglycemIa in POrtugal Study (HIPOS) was a sequence of three observational studies to capture the overall panorama of hypoglycemia events in Portugal in different settings of healthcare assistance: ambulatory (HIPOS-PHARMA) [ 16 ], emergency room (HIPOS-ER) [ 17 ], and hospitalizations (HIPOS-WARD). Their main objective was to assess the clinical characteristics of patients with DM enrolled by type of admission, and the resource consumption and corresponding costs were estimated as secondary objectives.…”

Hospitalization due to Hypoglycemia: A Cost to be considered in the Treatment of Diabetes mellitus type 2 in Portugal

“…Para compreender melhor o impacto clínico e económico dos episódios de hipoglicemia grave, associados ao tratamento da DM, foram conduzidos uma série de estudos observacionais transversais multicêntricos em Portugal (Programa HIPOS, Hypoglycemia In Portugal Observational Study). Esta série foi conduzida em três contextos de cuidados médicos, nomeadamente, em ambulatório (HIPOS-PHARMA), 16 na urgência (HIPOS-ER), 17,18 e em internamento hospitalar (HIPOS-WARD). 19 Não obstante o objetivo primário epidemiológico destes estudos, foi realizada uma análise económica secundária a partir da metodologia de microcusteio.…”

“…Destacamos ainda a elevada taxa de hospitalizações após ida à urgência (44,1%). 17 Neste estudo, apresentamos os resultados da análise económica combinada dos estudos HIPOS-ER 18 e HIPOS-WARD, 19 com o objetivo de mostrar o impacto económico total expectável durante o controlo de episódios de hipoglicemia grave que requerem internamento, considerando o circuito desde a ida à urgência até alta após internamento hospitalar.…”