Severe hypoglycemia (SH) is the most dangerous complication of diabetes treatment and the limiting factor in blood glucose (BG) management. This study retrospectively analyzed the clinical characteristics, causal factors, and medical costs of type 2 diabetic patients (T2DM) admitted for severe hypoglycemia to the emergency department (ED) of Perugia hospital, Italy, from 1 July 2005 to 30 June 2011. SH was defined as an event requiring assistance from another person administering carbohydrates or glucagon to correct hypoglycemia, identified on the basis of capillary BG measured by the ambulance crew or at the ED, using the ICD-9-CM discharge diagnosis code. There were 205 admissions, half of whom (107, 50.5%) were treated in the ED and discharged the same day. The other 98 (49.5%) required hospital admission. The characteristics of these latter were: age 78 ± 10 yrs (mean ± SD), duration of diabetes (15 ± 12 yrs), HbA1c (6.8 ± 1.5%; 51 ± 11,2 mmol/mol), renal function (estimated glomerular filtration rate 56 ± 32 ml/min/1.73 m2), associated comorbid conditions (Charlson Comorbidity Index 5.4 ± 2.1), use of more than three different medications (86%). More than half (57.1%) were using insulin, 41.8% oral agents; of the latter, more than half (61.7%) were taking a sulphonylurea, mainly glibenclamide. SH induced by SU was associated with a longer average length of stay (ALOS) (3.0 vs. 6.0 days) and the estimated average cost per ALOS was greater than that due to insulin (€4,500 vs. €2,250, not including the costs of the emergency telephone service and ambulance). In conclusion, these findings indicate that half of SH events in T2DM presenting to the ED require hospital admission and almost half are due to inappropriate use of SU, with a signi- ficant impact on patients’ health and healthcare costs
Ricoveri per ipoglicemia grave in soggetti con diabete mellito di tipo 2: impatto clinico e costi sanitari
MARINELLI ANDREOLI, ANNA;LUCIDI, Paola;PORCELLATI, Francesca;BOLLI, Geremia Brunetto;FANELLI, Carmine Giuseppe
2015
Abstract
Severe hypoglycemia (SH) is the most dangerous complication of diabetes treatment and the limiting factor in blood glucose (BG) management. This study retrospectively analyzed the clinical characteristics, causal factors, and medical costs of type 2 diabetic patients (T2DM) admitted for severe hypoglycemia to the emergency department (ED) of Perugia hospital, Italy, from 1 July 2005 to 30 June 2011. SH was defined as an event requiring assistance from another person administering carbohydrates or glucagon to correct hypoglycemia, identified on the basis of capillary BG measured by the ambulance crew or at the ED, using the ICD-9-CM discharge diagnosis code. There were 205 admissions, half of whom (107, 50.5%) were treated in the ED and discharged the same day. The other 98 (49.5%) required hospital admission. The characteristics of these latter were: age 78 ± 10 yrs (mean ± SD), duration of diabetes (15 ± 12 yrs), HbA1c (6.8 ± 1.5%; 51 ± 11,2 mmol/mol), renal function (estimated glomerular filtration rate 56 ± 32 ml/min/1.73 m2), associated comorbid conditions (Charlson Comorbidity Index 5.4 ± 2.1), use of more than three different medications (86%). More than half (57.1%) were using insulin, 41.8% oral agents; of the latter, more than half (61.7%) were taking a sulphonylurea, mainly glibenclamide. SH induced by SU was associated with a longer average length of stay (ALOS) (3.0 vs. 6.0 days) and the estimated average cost per ALOS was greater than that due to insulin (€4,500 vs. €2,250, not including the costs of the emergency telephone service and ambulance). In conclusion, these findings indicate that half of SH events in T2DM presenting to the ED require hospital admission and almost half are due to inappropriate use of SU, with a signi- ficant impact on patients’ health and healthcare costsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
