Imhof, Lorenz

Keller-Senn, Anita

Lee, Gerry

Sturt, Jackie

ZHAW digitalcollection

Patients with severe diabetic hypoglycaemia in Swiss emergency care services Anita Keller-Senn (PhD student, MScN, RN)1,2,3, Gerry Lee (PhD, RN)1, Lorenz Imhof (PhD, RN)4, Jackie Sturt (PhD, RN)11King’s College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom; 2Zurich University of Applied Sciences, Institute of Nursing, Winterthur, Switzerland; 3Cantonal Hospital Winterthur, Department of Medicine, Winterthur, Switzerland; 4Nursing Science & Care GmbH, Winterthur, SwitzerlandSampleN=43EMSn=12EDn=3EMS and EDn=28Diabetes type, n(%)Type 1Type 219  (45.2%)23  (54.8%)8  (72.7%)3  (27.3%)- -3  (100%)11  (39.3%)17  (60.7%)Diabetes since (years), M(±SD)Type 1Type 220.54 (±10.2)16.00 (±10.4)23.42 (±4.1)12.00 (±0.0)- -17.00 (±0.0)17.17 (±14.3)16.31 (±10.7)Diabetic medication, n(%)Antihyperglycaemic agentsInsulinCombination3  (7.3%)29 (70.7%)9 (22.0%)- -10  (100%)- -2  (66.7%)1  (33.3%)- -1   (3.6%)18  (64.3%)9  (32.1%)HbA1c,(mmol/L), M(±SD) 7.70 (±1.2) 7.54 (±1.1) 7.45 (±2.0) 7.84 (±1.2)BackgroundHypoglycaemia is the most common complicationassociated with diabetic medication and represents thegreatest barrier in achieving and maintaining goodglycaemic control(1). Severe hypoglycaemic events(SHE) are the most frequent reason for people withdiabetes to require emergency service treatment(2).AimThe aim of this study was to explore SHE of patientspresenting to a Swiss emergency service, includingpre-hospital care with emergency medical service(EMS) and emergency department (ED) presentationsto ascertain: number of patients requiring EMS & ED treatment, characteristics of presenting patients.MethodRetrospective data collection in a single Swiss ED and its EMS was undertaken of alladult patients with type 1 and 2 diabetes. All participants were treated in the ED and/orEMS due to SHE between 01/01/2014 and 31/12/2014.Data were retrieved from the electronic sources onto study specific case report forms.Descriptive analysis was conducted, including frequency and distribution of singlevariables, such as central tendency (mean) and dispersion (range or standard deviation).Ethical approval from the Swiss cantonal ethics committee was obtained before studystart (KEK-ZH-Nr. 2015-0276).ResultsNumber of patients requiring EMS & ED treatmentIn 36 patients with diabetes a total of 43 SHE wasidentified. Of the 43 events, 28% (n=12) involvedcontact with the EMS only, 7% (n=3) were seen by theED but did not use EMS, and 65% (n=28) ofpresentations used EMS and were then taken to theED.Patient characteristics54% (n=23) events occurred in males with a medianage of 65.1 years (SD±17.5). More than half of thepatients were retired (n= 24; 56%), and 56% (n=24)were married or living with a partner. The initial meanblood glucose in all presenting patients was 2.1mmol/L(SD±0.8) regardless at their place of care. Furthermedical characteristics are shown in table 1.The 12 patients who were treated by EMS only anddischarged to everyday life environment weresignificantly younger compared to those admitted toED (EMS patients discharged to everyday life: Md=54years vs. EMS patients discharged to ED: Md=72years; U=98.000; p=.039). Those patients did not differin the initial glucose meter reading, gender, type ofdiabetes, or diabetic medication.In 20 cases, the ED presentation led to an in-hospitaladmission. A comparison between patients dischargedand in-patients showed a significant difference in theirage (ED patients discharged home: M=61 years vs.ED patients with in-hospital follow-up: M=73 years; T=-2.265; p=.031). Also in this group, no differences werefound in the initial glucose meter reading, gender, typeof diabetes, or diabetic medication.Table 1: Medical characteristicsImplications for practiceThe patients most likely to suffer a SHEare men, living with a partner, and areover 65 years old. Furthermore, they areliving with a diabetes type 2 since morethan 10 years. These findings help toidentify patients most at risk and thosewho would benefit from preventiveinterventions.DiscussionMost patients affected by SHE were male, over 65 years of age, living with a partner, andsuffering type 2 diabetes over a decade. Interestingly, younger patients treated by EMS athome tend to remain at home in contrast to the older patients who were admitted tohospital. This was also true for the emergency department where older people in particular(>72 years) became in-patients after such an event. As the older population grows rapidly,this is an important finding for future interventions to be developed in order to minimizehospital admissions.Implications for researchThese results will inform an ongoinggrounded theory study looking atpatients needs after experiencing a SHE.Based on the results of both studies,brief interventions for the affectedpatients will be developed.References(1) Brod, M., Christensen, T., Thomsen, T. L., & Bushnell, D. M. (2011). The impact of non-severehypoglycemic events on work productivity and diabetes management. Value Health, 14(5), 665-671.(2) Brackenridge, A., Wallbank, H., Lawrenson, R. A., & Russell-Jones, D. (2006). Emergencymanagement of diabetes and hypoglycaemia. Emergency Medicine Journal, 23(3), 183-185.SponsorThis projects  has   been funded by   the   Nursing Science FoundationSwitzerland.Contactanita.keller-senn@kcl.ac.uk or anita.keller-senn@zhaw.ch

Patients with severe diabetic hypoglycaemia in Swiss emergency care services

ZHAW Zürcher Hochschule für Angewandte Wissenschaften

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Patients with severe diabetic hypoglycaemia in Swiss emergency care services

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