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.
  
  
• Keywords:
  Age Factors Data Collection Diabetes Mellitus Drug-Related Side Effects And Adverse Reactions Emergency Service, Hospital Female Hospitalization Humans Hypoglycemia Hypoglycemic Agents Insulin Male Medication Errors Public Health Surveillance Sex Factors United States

  More +
• Source:
  JAMA Intern Med. 174(5):678-686
• Pubmed ID:
  24615164
• Pubmed Central ID:
  PMC4631022
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  174
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f6a6e7264de6c38c01498979d015d55744d23ebff6e00b803ba0fb52fd694ada
• Download URL:
  https://stacks.cdc.gov/view/cdc/36390/cdc_36390_DS1.pdf
• File Type:
  [PDF - 1.53 MB ]