Oral glucose, normal consciousness lower risk for poor outcomes with severe hypoglycemia
People with diabetes who require emergency assistance due to hypoglycemia were less likely to require parenteral therapy if they had a higher glucose level, normal consciousness or received oral glucose treatment, according to study data.
“Parenteral treatment can be lifesaving and is often reserved for severe cases of hypoglycemia, particularly when the ability to ingest oral glucose is compromised,” Chukwuma Uduku, MBBS, BSc, MRCP, a clinical research fellow in endocrinology, diabetes and internal medicine at Imperial College London, and colleagues wrote in a study published in Diabetic Medicine. “Our findings suggest that early noninvasive interventions such as oral glucose may reduce the need for invasive parenteral rescue treatment. This is further reflected by the finding that oral glucose treatment, higher blood glucose levels and intact consciousness at the completion of on-scene treatment are negative predictors for hospital conveyance.”
Researchers conducted a retrospective review of cases in which the London Ambulance Service NHS Trust responded to calls for adult or pediatric hypoglycemia from Jan. 1 to June 30, 2018. Those with confirmed type 1 or type 2 diabetes were included in the analysis. Data on age, gender, emergency medical services (EMS) response time, seizures, respiratory rate, pulse rate, systolic and diastolic blood pressure, use of oral glucose therapy, parenteral glucose or glucagon therapy, capillary glucose and intact consciousness on arrival and before leaving the scene were obtained through the ambulance service clinical database.
There were 2,862 cases of emergency hypoglycemia included in the analysis, with 1,503 people having type 1 diabetes and 1,359 with type 2 diabetes. Those with type 1 diabetes were younger compared with the type 2 diabetes group (median age, 55 years vs. 75 years) and had a shorter mean EMS response time (10.9 minutes vs. 12.1 minutes). Median blood glucose at EMS arrival was slightly lower in the type 1 diabetes group compared with those with type 2 diabetes (2.3 mmol/L vs. 2.5 mmol/L).
The rate of incidents labeled as hypoglycemia by the EMS call handler was 19% higher in those with type 1 diabetes compared with type 2 diabetes, and the rate of hospitalization was 28% lower in those with type 1 diabetes. The percentage of people with type 1 diabetes receiving parenteral therapy was higher compared with type 2 diabetes (53.6% vs. 46.2%).
People with type 1 diabetes were less likely to require hospitalization compared with type 2 diabetes (OR = 0.37; 95% CI, 0.21-0.66; P < .01). A longer EMS response interval was a negative predictor for receiving parenteral therapy (OR = 0.98; 95% CI, 0.96-0.99; P = .03).
People with a higher capillary blood glucose level (OR = 0.22; 95% CI, 0.16-0.31; P < .01) and normal consciousness (OR = 0.13; 95% CI, 0.07-0.24; P < .01) were less likely to require parenteral therapy. The odds for hospitalization were also reduced with a higher blood glucose (OR = 0.92; 95% CI, 0.85-0.99; P = .04) and normal consciousness (OR = 0.08; 95% CI, 0.03-0.21; P < .01).
People who received oral glucose treatment had lower odds of needing parenteral therapy (OR = 0.02; 95% CI, 0.01-0.07; P < .01) and hospitalization (OR = 0.25; 95% CI, 0.14-0.45; P < .01). Parenteral therapy increased the likelihood for hospitalization (OR = 2.52; 95% CI, 1.46-4.33; P < .01).
The researchers said the findings could be used to help improve early intervention, education and accessibility or risk prevention strategies to reduce the need for parenteral treatment and hospitalization in people with emergency hypoglycemia.
“Greater allocation of resources providing access to hypoglycemia prevention tools in both diabetes categories, with more emphasis on identifying and self-treating hypoglycemia are needed to curtail the economic burden of emergency hypoglycemia,” the researchers wrote.