Follow up care for adults with diabetes treated for severe hypoglycemia by emergency medical Services, 2013-2019

被引:0
作者
Rode, Matthew M. [1 ]
Boggust, Brett A. [2 ]
Manggaard, Jennifer M. [3 ]
Myers, Lucas A. [4 ]
Swanson, Kristi M. [5 ]
McCoy, Rozalina G. [3 ,4 ,5 ,6 ,7 ]
机构
[1] Mayo Clin, Alix Sch Med, Rochester, MN 55905 USA
[2] Creighton Univ, Sch Med, Omaha, NE 68178 USA
[3] Mayo Clin, Dept Med, Div Community Internal Med Geriatr & Palliat Care, Rochester, MN USA
[4] Mayo Clin, Ambulance Serv, Rochester, MN 55905 USA
[5] Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN USA
[6] Univ Maryland, Div Endocrinol Diabet & Nutr, Dept Med, Sch Med, 670 West Baltimore St, Baltimore, MD 21201 USA
[7] Univ Maryland, Inst Hlth Comp, Bethesda, MD USA
关键词
Hypoglycemia; Glucagon; Emergency medical services; Diabetes complication; Health care delivery; ALL-CAUSE MORTALITY; CARDIOVASCULAR-DISEASE; TYPE-1; COMPLICATIONS; MANAGEMENT; RISK; CHILDHOOD; PEOPLE; BURDEN; IMPACT;
D O I
10.1016/j.diabres.2024.111741
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: To capture the types and content of healthcare encounters following severe hypoglycemia requiring emergency medical services (EMS) and to correlate their features with subsequent risk of severe hypoglycemia. Methods: A retrospective cohort was obtained by linking data from a multi-state health system and an advanced life support ambulance service. This identified 1977 EMS calls by 1028 adults with diabetes experiencing hypoglycemia between 1/1/2013-12/31/2019. We evaluated the healthcare engagement over the following 7 days to identify rates of discussion of hypoglycemia, change of diabetes medications, glucagon prescribing, and referral for diabetes. Results: Rates of hypoglycemia discussion increased with escalating levels of care, from 11.5 % after EMS calls without emergency department (ED) transport or outpatient clinical encounters to 98 % among hospitalized patients with outpatient follow-up. EMS transport and outpatient follow-up were associated with significantly higher odds of discussion of hypoglycemia (OR 60 and OR 22.1, respectively). Interventions were not impacted by previous severe hypoglycemia within 30 days. Prescription of glucagon was rare among all patients. Conclusions: Interventions to prevent recurrent hypoglycemia increase with escalating levels of care but remain inadequate and inconsistent with clinical guidelines. Greater attention is needed to ensure timely diabetesrelated follow-up and treatment modification for patients experiencing severe hypoglycemia.
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页数:10
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