Recurrent hypoglycemia more frequent with lower initial blood glucose
NEW ORLEANS — Lower blood glucose levels and treatment with non-oral glucose medications before receiving emergency medical services, or EMS, during an episode of hypoglycemia may result in additional need for EMS, according to findings presented at the Endocrine Society Annual Meeting.
“Many EMS systems are adopting treat-and-release protocols designed to identify patients who can safely be treated for hypoglycemia in the field without resource-intensive evaluation in an emergency department,” Mark J. O'Connor, MD, of Massachusetts General Hospital in Boston, told Endocrine Today. “This study sheds light on factors that should be taken into consideration when creating such protocols.”
O'Connor and colleagues retrospectively reviewed charts of 549 patients (mean age, 55 years; 35% women) who experienced hypoglycemia and were treated before reaching a hospital with either oral glucose, parenteral dextrose or intramuscular glucagon. Data were collected for 1 year and in the year after hospitalization.
More patients elected to receive EMS and were transported to the hospital than not (81% vs. 19%). For patients who did go to the hospital, 10% required EMS again in the next year, with 3% requiring EMS three or more times. The researchers noted that those who had to return to the hospital multiple times had lower mean blood glucose levels at baseline compared with those who did not require more than one visit (38 mg/dL vs. 44 mg/dL; P = .006). Being treated with something besides oral glucose led to more frequent instances of multiple uses of EMS than single or no use (51% vs. 28%; P < .001).
“Our findings show that in patients requiring emergency assistance for hypoglycemia, lower initial blood sugar is associated with higher risk for recurrent EMS utilization, suggesting that these patients may require more intensive intervention,” O’Connor said. “The data also suggest that there may be a population of patients who can safely be treated for hypoglycemia by EMS in the field, as people who refused transportation to the hospital were not at higher risk for future hypoglycemia.” – by Phil Neuffer
Editor’s note: On April 1, we corrected the headline to clarify that the researchers reported a reduction in recurrent hypoglycemia, and we added that 35% of patients were women. We regret the error.
O'Connor MJ, et al. MON-169. Characteristics of patients with recurrent EMS utilization for hypoglycemia in a large urban system. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.
Disclosures: The authors report no relevant financial disclosures.