National Estimates of Insulin-related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations

Details

• Alternative Title:
  JAMA Intern Med
• Personal Author:
  Geller, Andrew I. ; Shehab, Nadine ; Lovegrove, Maribeth C. ; Kegler, Scott R. ; Weidenbach, Kelly N. ; Ryan, Gina J. ; Budnitz, Daniel S.
• Description:
  Importance ; Detailed, nationally-representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets. ; Objective ; Describe U.S. burden, rates, and characteristics of emergency department (ED) visits and emergent hospitalizations for IHEs. ; Design ; Nationally-representative, public health surveillance of adverse drug events and a national, household survey of insulin use. ; Setting ; National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES), 2007-2011 and National Health Interview Survey (NHIS), 2007-2011. ; Participants ; Insulin-treated patients seeking ED care. ; Main outcome(s) and Measures ; Estimated annual numbers and estimated annual rates of ED visits and hospitalizations for IHEs among insulin-treated patients with diabetes. ; Results ; Based on 8,100 cases, an estimated 97,648 (95% confidence interval CI, 64,410-130,887) ED visits for IHEs occurred annually; almost one-third (29.3% CI, 21.8%-36.8%) resulted in hospitalization. Severe neurologic sequelae were documented in an estimated 60.6% (CI, 51.3%-69.9%) of ED visits for IHEs, and glycemic levels ≤50 mg/dL were recorded in over one-half of cases (53.4%). Insulin-treated patients aged ≥80 years were more than twice as likely to visit the ED (rate ratio, 2.5; CI, 1.5-4.3) and nearly five times as likely to be subsequently hospitalized (rate ratio, 4.9; CI, 2.6-9.1) for IHEs than those aged 45-64 years. The most commonly-identified IHE precipitants were reduced food intake and administration of the wrong insulin product. ; Conclusions and Relevance ; Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients aged ≥80 years; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning and insulin product mix-up misadventures are important targets for hypoglycemia prevention efforts.
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• Keywords:
  • Age Factors
  • Data Collection
  • Diabetes Mellitus
  • Drug-Related Side Effects and Adverse Reactions
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Hypoglycemia
  • Hypoglycemic Agents
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• Source:
  JAMA Intern Med. 174(5):678-686
• Pubmed ID:
  24615164
• Pubmed Central ID:
  PMC4631022
• Document Type:
  Text
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  174
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/36390/cdc_36390_DS1.pdf
• File Type:
  [PDF - 1.53 MB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:db892719e3e2d7a03118a0c4c08e2810ebe38728a70377f81f65549ed99e9833a014a0e5eef78f33569b57d39983735404daaf5c715c3ea488a9d4fe64285628