To report the frequency of severe hypoglycemic events (SHGE), demographic and clinical characteristics of diabetic patients admitted into the Emergency Department (ED) of a general hospital.
We identify patients presenting with SHGE associated with anti-hyperglycemic treatment using the daily epidemiologic report of Hospital San Juan de Dios. Pertinent clinical characteristics, capillary glycaemia, co-morbidities, length of stay, and anti-hyperglycemic treatment of diabetic patients presenting SHGE were investigated. Healthcare costs linked to admission into ED with SHGE was also assessed.
Results : From March to July 2018, 55620 patients were attended at the ED. 4434 of them had chronic non-communicable conditions including 961 diabetics. Among them, 90 presented hypoglycemia. Clinical data of 61 diabetics with hypoglycemia was analyzed. There were 37 females aged 70 ± 16.01 years and 24 males aged 62.9 ± 13.4 years (mean ± SD); 16.3 % had cardiovascular disease, 11.4 % had cerebrovascular disease and 19.6 % had renal disease. In females mean capillary glucose level was 42 ± 15.44 mg/dl and in males 32.6 ± 8.8 mg/dL (p=ns). Four patients had 2 episodes of SHGE and another patient presented seizures. The most frequenthypoglycemic agent associated with SHGE was human insulin. There were two cases of SHGE associated to glibenclamide and in three cases the medication was not documented. Of those on insulin, 22 were also treated with metformin. None required hospitalization and all were treated with IV glucose infusion. The length of stay in ED was 3.46 ± 5.3 hours. The costs for the health care system per patient´s visits are approximately 693 ± 303 dollars representing an overall cost of 42.3000 US dollars. Patient`s costs due to loss of working hours or potentialdisability due to SHGE were not evaluated.
This study explores the significance of SHGE in the ED of a tertiary hospital. Limitations of this report include incomplete clinical information and lack of patient´s follow-up, thus consequences for the patients were unknown. The severity of hypoglycemia could have triggered future cardiovascular events and aggravate cognitive dysfunction in type 2 diabetic patients.
Iatrogenic hypoglycemia represents an important and unexplored complication associated to diabetes treatment. SHGE was documented in 1.37 % of diabetic patients admitted in the ED during a six-month period of one the three general hospitals in the Metropolitan Area of San José. Better ambulatory glycemic management strategies and evaluation of current pharmacologic approaches is recommended in this country.
Irene Hernandez-Saborío– Dept of Epidemiology, Hospital San Juan de Dios, San Jose, Costa Rica
Alejandro Cob-Sanchez– Head Dept of Endocrinology, Hospital San Juan de Dios, University of Costa Rica, San Jose, Costa Rica
Jose Jimenez-Montero– Dept Endocrinology and School of Medicine, Universidad de Ciencias Médicas, Hospital CIMA San Jose, Escazu, San Jose, Costa Rica
irene Hernadez-Saborio– , Costa Rica
Dept of Epidemiology
Hospital San Juan de Dios, San Jose, Costa Rica
Professor of Epidemiology, Post Graduate Studies, Universidad de Ciencias Médicas
Head Dept of Endocrinology, Hospital San Juan de Dios
University of Costa Rica, San Jose, Costa Rica
Head of the Dept of Endocrinology and Director of the Endocrine Fellowship program of the University of Costa Rica
Dept Endocrinology and School of Medicine, Universidad de Ciencias Médicas
Hospital CIMA San Jose
Escazu, San Jose, Costa Rica
President of the Costa Rica Society of Endocrinology and Metabolism. Ex-President of the Costa Rica AACE Chapter. Professor of Medicine, School of Medicine, Universidad de Ciencias Médicas.