Hypoglycemic Events in the Emergency Department

• Published in: Endocrine practice Vol. 28; no. 4; p. 372
• Main Authors: Maheswaran, Anjana Bairavi, Gimbar, Renee Petzel, Eisenberg, Yuval, Lin, Janet
• Format: Journal Article
• Language: English
• Published: United States 01.04.2022
• Subjects: Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Emergency Service, Hospital; Female; Glucagon - therapeutic use; Humans; Hypoglycemia - chemically induced; Hypoglycemic Agents - therapeutic use; Insulin - adverse effects; Male; Retrospective Studies; United States; United States; management of hypoglycemia in acute care setting; underutilization of glucagon for anticipatory management of hypoglycemia; prevalence of glucagon prescription in the emergency room
• ISSN: 1530-891X
• DOI: 10.1016/j.eprac.2022.01.006

In the United States, hypoglycemic events contribute to 100 000 emergency department (ED) visits, costing $120 million annually. Hypoglycemia hinders glycemic management in people living with diabetes. Glucagon is the first line of treatment for severe hypoglycemia that is administrable by a caregiver in a nonclinical setting. However, there is a paucity of evidence on how frequently glucagon is prescribed for the anticipatory management of hypoglycemia, especially in ED. A retrospective study of patients seen with hypoglycemic events in an urban ED between 2016 and 2018 was performed to characterize gaps in prescription and use of glucagon for the anticipatory management of severe hypoglycemia. We identified 232 patients with a documented history of type 1 diabetes mellitus or type 2 diabetes mellitus who were seen in the ED with hypoglycemia. The majority of the patients were women (59%), African American (57%), and covered by public insurance (76%). Eighty-four percent of the patients had type 2 diabetes mellitus, 75% were receiving treatment with hypoglycemic medications, and 61% were receiving treatment with insulin. The prevalence of glucagon prescription was only 3% in this sample, and only 12% of the patients had received formal diabetes education in the year before the ED visit. Despite its proven efficacy in the management of severe hypoglycemia, glucagon is underused. This may be due to the lack of awareness, education, or training among both providers and patients. ED providers should be educated on prescribing glucagon and its use as a tool for the self-management of hypoglycemia. Patients at risk of hypoglycemia and their families need to be educated on the efficacy and use of glucagon.