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National Estimates of Insulin-related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations
  • Published Date:
    May 2014
  • Source:
    JAMA Intern Med. 174(5):678-686
  • Language:
Filetype[PDF-1.53 MB]

  • Alternative Title:
    JAMA Intern Med
  • Description:

    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.


    Describe U.S. burden, rates, and characteristics of emergency department (ED) visits and emergent hospitalizations for IHEs.


    Nationally-representative, public health surveillance of adverse drug events and a national, household survey of insulin use.


    National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance (NEISS-CADES), 2007–2011 and National Health Interview Survey (NHIS), 2007–2011.


    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.


    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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