Hipoglucemia en las urgencias hospitalarias españolassituación actual y pronóstico. Estudio global SAHU

1. Pablo Matías Soler ¹
2. Luis Picazo García ²
3. Ricardo Mesanza Forés ³
4. Marina Gil Mosquera ¹
5. Laura de Pedro Álvarez ⁴
6. Arturo Corbatón Anchuelo ¹
7. Laura Mariel Matus ⁵
8. Ricardo Muñoz Albert ⁶
9. María Ángeles San Martín Díez ⁷
10. Ainhona Burzaco Sánchez ⁷
11. Aitor Odiaga Andicoechea ⁸
12. Andreaa Irimia ⁹
13. Rosana Soriano Barrón ¹⁰
14. Esther Ruescas Esculano ¹¹
15. Mireia Cramp Vinceixo ¹²
16. Fahd Beddar Chaib ¹³
17. Esther Álvarez Rodríguez ¹⁴
18. Beatriz Mañero Criado ¹⁵

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DOI: 10.55633/S3ME/REUE004.2025 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Revista Española de Urgencias y Emergencias

Abstract

OBJECTIVE. To describe the characteristics of patients attended for hypoglycemia in emergency departments (EDs), the causes of hypoglycemic episodes, and treatments prescribed. To evaluate adherence to the consensus-based treatment guidelines issued by Spanish scientific associations. METHODS. Retrospective multicenter cohort study of cases treated in 11 Spanish hospitals (3, tertiary care; 8, secondary care). We reviewed records for patients over the age of 18 years attended for hypoglycemia in EDs between July 1, 2018, and July 31, 2019. Multiple logistic regression analyses were performed. RESULTS. A total of 978 patients (51.1%, men) were included. The median age was 73.3 years. The median hospital stay was 1 day; 90.3% of the patients had diabetes (82.3%, type 2), and 76.9% had a Charlson Comorbidity Index of 3 or higher. Insulin was the antidiabetic treatment the majority (72.6%) were using. Inadequate caloric intake was the most common cause of hypoglycemia (in 29.8%). A dextrose solution (5% or 10%) was used to correct hypoglycemia in 58.7%. Treatment in acute cases of hypoglycemia ollowed protocols in 36.2% of the ED cases; at discharge, treatment protocols were followed in 50.5% of cases. ED revisits were recorded for 23.6% at 30 days and for 36.8% at 90 days. Metabolic decompensation accounted for 26% of revisits within 30 days and 23% within 90 days. The 30-day and 90-day mortality rates were 6.7% and 8.9%, respectively. Hazard ratios (HRs) indicated that adherence to established protocols on discharge was associated with lower probability of ED revisiting at 30 days and 90 days, respectively, as follows: HR 0.45 (95% CI, 0.35-0.58) and HR 0.37 (95% CI, 0.26-0.53) for all-cause revisits; and HR 0.37 (95% CI, 0.19-0.72) and HR 0.44 (95% CI, 0.26-0.74) for revisits related to metabolic decompensation. CONCLUSIONS. The most common profile of patients treated for hypoglycemia in EDs is a frail person of advanced age with type2 diabetes under treatment with insulin. Inadequate caloric intake is the most common cause of hypoglycemic emergencies. Emergency physicians' adherence to established protocols for treating hypoglycemia is low. Adherence to protocols for prescribing antidiabetic treatment at discharge is also low. Adherence is an independent factor that reduces the frequency of revisits, either for all causes or for metabolic decompensation.

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