Trends in hospital admissions for hypoglycaemia in England: a retrospective, observational study

Zaccardi, Francesco; Davies, Melanie J.; Dhalwani, Nafeesa N.; Webb, David R.; Housley, Gemma; Shaw, Dominick; Hatton, James W.

doi:10.1016/s2213-8587(16)30091-2

Cited by 66 publications

(74 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, there was a lower median HbA1c concentration in the FDS2 than in the FDS1 (51 mmol/mol or 6.8% vs 55 mmol/mol or 7.2%) suggesting that the newer blood glucose‐lowering therapies may have contributed to better glycaemic control without increasing the risk of severe hypoglycaemia. There have been other relatively contemporaneous large‐scale, population‐based longitudinal studies of severe hypoglycaemia in various countries which have either shown no change in rates or a decline which, allowing for factors such as lack of differentiation between type 1 and 2 diabetes, use of hospitalization alone in ascertainment, and/or absence of HbA1c data to provide an indication of treatment intensity, are not inconsistent with the present findings.…”

Section: Discussionsupporting

confidence: 46%

Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Davis

Bruce

Finn

et al. 2018

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim To determine the incidence of severe hypoglycaemia and its predictors in community‐based patients with type 2 diabetes studied between 2008 and 2013 compared with those in a cohort of patients with type 2 diabetes from the same geographical area assessed a decade earlier. Methods We studied 1551 participants (mean age 65.7 years, 51.9% men) with type 2 diabetes from the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). Severe hypoglycaemia was ascertained as that requiring ambulance attendance, emergency department services and/or hospitalization. Cox proportional hazards modelling was used to determine predictors of a first episode of severe hypoglycaemia, and negative binomial regression was used to identify predictors of frequency. Results Sixty‐three participants (4.1%) experienced 83 episodes, representing an incidence of 1.34/100 participant‐years (95% confidence interval [CI] 1.08 to 1.67; vs 1.67/100 participant‐years [95% CI 1.31‐2.13] in the Fremantle Diabetes Study Phase I [FDS1]; P = 0.18). Those experiencing severe hypoglycaemia experienced one to four episodes in both cohorts. The independent predictors of incident severe hypoglycaemia in the FDS2 were: older age; higher educational attainment; alcohol consumption; current smoking; sulphonylurea/insulin treatment; prior severe hypoglycaemia; renal impairment; and plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). The same variables except smoking were associated with frequency of severe hypoglycaemia. Most of these risk factors paralleled those in the FDS1, but current smoking and plasma NT‐proBNP were novel. Conclusions The incidence and frequency of severe hypoglycaemia did not change between the Fremantle Diabetes Study phases but novel risk factors, including plasma NT‐proBNP, were observed in the FDS2.

show abstract

Section: Discussionsupporting

confidence: 46%

Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Davis

Bruce

Finn

et al. 2018

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Rising trends in severe hypoglycaemia (resulting in emergency department visit or hospital admissions) have been reported in recent years for several high-SDI countries (USA, Canada, Japan, England) [14][15][16][17][18]. Most of these studies revealed a peak (2007 in the USA [14], 2006 in Canada and 2010 in Japan and England) followed by more stable trends.…”

Section: Discussionmentioning

confidence: 99%

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

et al. 2018

Self Cite

View full text Add to dashboard Cite

Aims/hypothesis In the context of increasing prevalence of diabetes in elderly people with multimorbidity, intensive glucose control may increase the risk of severe hypoglycaemia, potentially leading to death. While rising trends of severe hypoglycaemia rates have been reported in some European, North American and Asian countries, the global burden of hypoglycaemia-related mortality is unknown. We aimed to investigate global differences and trends of hypoglycaemia-related mortality. Methods We used the WHO mortality database to extract information on death certificates reporting hypoglycaemia or diabetes as the underlying cause of death, and the United Nations demographic database to obtain data on mid-year population estimates from 2000 to 2014. We calculated crude and age-standardised proportions (defined as number of hypoglycaemia-related deaths divided by total number of deaths from diabetes [i.e. the sum of hypoglycaemia-and diabetes-related deaths]) and rates (hypoglycaemia-related deaths divided by mid-year population) of hypoglycaemia-related mortality and compared estimates across countries and over time.Results Data for proportions were extracted from 109 countries (31 had data from all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised proportion of hypoglycaemia-related deaths was 4.49 (95% CI 4.44, 4.55) per 1000 total diabetes deaths. Compared with the overall mean, most Central American, South American and (mainly) Caribbean countries reported higher proportions (five more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths in Chile, six in Uruguay, 11 in Belize and 22 in Aruba), as well as Japan (11 more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths). In comparison, lower proportions were noted in most European countries, the USA, Canada, New Zealand and Australia. For countries with data available for all years analysed, trend analysis showed a 60% increase in hypoglycaemia-related deaths until 2010 and stable trends onwards. Rising trends were most evident for Argentina, Brazil, Chile, the USA and Japan. Data for rates were available for 105 countries (30 had data for all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised hypoglycaemia-related death rate was 0.79 (95% CI 0.77, 0.80) per 1 million person-years. Most Central American, South American and Caribbean countries similarly reported higher rates of hypoglycaemia-related death, whilst virtually all European countries, the USA, Canada, Japan, New Zealand and Australia reported lower rates compared with the overall mean. Age-standardised rates were very low for most countries (lower than five per 1 million person-years in 89.5% of countries), resulting in small absolute differences among countries. As noted with the proportions analysis, trend analysis sho...

show abstract

“…This low rate may be an underestimate, and may reflect a tendency in Ambulance crew conveying patients to emergency hospital care not to pass patient details through to the SPOC pathway. Recent analysis of hospital admissions for severe hypoglycaemia [25] in England based on Hospital Episode Statistics (HES) data suggested a decline in admission rates for SH between 2011 and 2014 adjusted for diabetes prevalence.…”

Section: Discussionmentioning

confidence: 99%

A new integrated care pathway for ambulance attended severe hypoglycaemia in the East of England: The Eastern Academic Health Science Network (EAHSN) model

Sampson

Bailey

Clark

et al. 2017

Diabetes Research and Clinical Practice

View full text Add to dashboard Cite

A new integrated care pathway for Ambulance attended severe hypoglycaemia in the East of England: the Eastern Academic Health Science Network (EAHSN) model, Diabetes Research and Clinical Practice (2017), doi: http://dx.doi.org/10.1016/ j.diabres. 2017.08.017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods SH patients attended by Ambulance crew receive written information on SH avoidance, and are contacted for further education through a new regional SH prevention team. All patients are contacted unless they actively decline.Results Median age (IQR) was 67 (50 -80) years, 23.6% of calls were for patients over 80 years old, and patients more than 90 years old were more common than 20 -25 year olds in this population. Most calls were for patients (84.9%) who were insulin treated, even those over 80 years (75%). One -third of patients attended after a call were unconscious on attendance. 5.6% of patients in this call population had 3 or more ambulance call outs, and they generated 17.6% of all calls. In total, 728 episodes (36.4%) were repeat calls. Insulin related events were clinically more severe than oral hypoglycaemic related events. Patients conveyed to hospitals (13.8%) were significantly older, with poorer recovery in biochemical hypoglycaemia after ambulance crew attendance. Only 19 (1 %) opted out of further contact. Patients were contacted by the SH prevention team after a median 3 (0 -6) days. The most common patient self -reported cause for their SH episode was related to percieved errors in insulin management (31.4%). ConclusionsThis new clinical service is simple, acceptable to patients, and a translatable model for prevention of recurrent SH in this largely elderly insulin treated SH population.

show abstract

Trends in hospital admissions for hypoglycaemia in England: a retrospective, observational study

Cited by 66 publications

References 30 publications

Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

A new integrated care pathway for ambulance attended severe hypoglycaemia in the East of England: The Eastern Academic Health Science Network (EAHSN) model

Contact Info

Product

Resources

About