Management and Outcomes of Severe Hypoglycemia Treated by Emergency Medical Services in the U.S. Upper Midwest
Objective. To examine factors associated with emergency department (ED) transport after hypoglycemia treated by emergency medical services (EMS) and assess the impact of ED transport on severe hypoglycemia recurrence.
Research Design and Methods. We retrospectively analyzed electronic health records of a multi-state advanced life support EMS provider and an integrated healthcare delivery system serving an overlapping geographic area in the Upper Midwest. For adults with diabetes treated by EMS for hypoglycemia between 2013-2019, we examined rates of ED transport, factors associated with it, and its impact on rates of recurrent hypoglycemia requiring EMS, ED, or hospital care within 3, 7, and 30 days.
Results. We identified 1977 hypoglycemia-related EMS encounters among 1028 adults with diabetes (mean age 63.5 years [SD, 17.7], 55.2% male, 87.4% Non-Hispanic White, 42.4% rural residents, 25.6% with type 1 diabetes) of which 46.4% resulted in ED transport (31.1% of calls by patients with type 1 diabetes and 58.0% of calls by patients with type 2 diabetes). Odds of ED transport were lower in patients with type 1 diabetes (OR 0.44 [95% CI 0.31-0.62] vs. type 2 diabetes) and higher in patients with prior ED visits (OR 1.38 [95% CI 1.03-1.85]). Within 3, 7, and 30 days, transported patients experienced recurrent severe hypoglycemia 2.8%, 5.2%, and 10.6% of the time, respectively, compared to 7.4%, 11.2%, and 22.8% of the time among non-transported patients; all p<0.001. This corresponds to OR 0.58 (95% CI 0.42-0.80) for recurrent severe hypoglycemia within 30 days for transported vs. non-transported patients. When subset by diabetes type, odds of recurrent severe hypoglycemia among transported patients were 0.64 (95% CI 0.43-0.96) and 0.42 (95% CI 0.24-0.75) in type 1 and type 2 diabetes, respectively.
Conclusions. Transported patients experienced recurrent hypoglycemia requiring medical attention approximately half as often as non-transported patients, reinforcing the importance of engaging patients in follow-up to prevent recurrent events.