Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes

a population-based data-linkage cohort study

Huan Wang (Lead / Corresponding author), Peter T. Donnan, Callum J. Leese, Edward Duncan, David R. Fitzpatrick, Brian M. Frier, Graham P. Leese

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Abstract

Background: Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.

Methods: The study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients' data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997-1998 in the same region.

Results: In January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4% (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7% (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95% CI: 0.094-0.136) to 0.082 (0.073-0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095-0.141) to 0.037 (0.003-0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.

Conclusions: Although from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.

Original languageEnglish
Article number7
Pages (from-to)1-8
Number of pages8
JournalClinical Diabetes and Endocrinology
Volume3
DOIs
Publication statusPublished - 15 Aug 2017

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Information Storage and Retrieval
Emergency Medical Services
Type 1 Diabetes Mellitus
Hypoglycemia
Type 2 Diabetes Mellitus
Cohort Studies
Emergency Treatment
Population
Incidence
Scotland
Insulin
Ambulances
Hospital Departments
Hospital Emergency Service
Therapeutics
Delivery of Health Care

Keywords

  • Diabetes
  • Hypoglycemia
  • Emergency medical care
  • Insulin
  • Sulfonylurea

Cite this

@article{39c51387f33d4e87bfd9a930e7eb0e8d,
title = "Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study",
abstract = "Background: Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.Methods: The study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients' data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997-1998 in the same region.Results: In January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4{\%} (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7{\%} (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95{\%} CI: 0.094-0.136) to 0.082 (0.073-0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095-0.141) to 0.037 (0.003-0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.Conclusions: Although from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.",
keywords = "Diabetes, Hypoglycemia, Emergency medical care, Insulin, Sulfonylurea",
author = "Huan Wang and Donnan, {Peter T.} and Leese, {Callum J.} and Edward Duncan and Fitzpatrick, {David R.} and Frier, {Brian M.} and Leese, {Graham P.}",
note = "Funding was received from Novo Nordisk for the support of a research fellow (HW) and data-linkage costs, and support of the Health Informatics Centre (HIC) in University of Dundee for managing and supplying the anonymised data.",
year = "2017",
month = "8",
day = "15",
doi = "10.1186/s40842-017-0045-0",
language = "English",
volume = "3",
pages = "1--8",
journal = "Clinical Diabetes and Endocrinology",
issn = "2055-8260",
publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes

T2 - a population-based data-linkage cohort study

AU - Wang, Huan

AU - Donnan, Peter T.

AU - Leese, Callum J.

AU - Duncan, Edward

AU - Fitzpatrick, David R.

AU - Frier, Brian M.

AU - Leese, Graham P.

N1 - Funding was received from Novo Nordisk for the support of a research fellow (HW) and data-linkage costs, and support of the Health Informatics Centre (HIC) in University of Dundee for managing and supplying the anonymised data.

PY - 2017/8/15

Y1 - 2017/8/15

N2 - Background: Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.Methods: The study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients' data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997-1998 in the same region.Results: In January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4% (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7% (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95% CI: 0.094-0.136) to 0.082 (0.073-0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095-0.141) to 0.037 (0.003-0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.Conclusions: Although from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.

AB - Background: Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. With subsequent improvements in the treatment of diabetes, concurrent with changes in the provision of emergency medical care, a decline in the frequency of severe hypoglycemia could be anticipated. The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes.Methods: The study population comprised all people with diabetes in Tayside, Scotland over the period 1 January 2011 to 31 December 2012. Patients' data from different healthcare sources were linked anonymously to measure the incidence rates of hypoglycemia requiring emergency medical services that include treatment by ambulance staff and in hospital emergency departments, and necessitated hospital admission. These were compared with data recorded in 1997-1998 in the same region.Results: In January 2011 to December 2012, 2029 people in Tayside had type 1 diabetes and 21,734 had type 2 diabetes, compared to 977 and 7678, respectively, in June 1997 to May 1998. In people with type 2 diabetes, the proportion treated with sulfonylureas had declined from 36.8 to 22.4% (p < 0.001), while insulin-treatment had increased from 11.7 to 18.7% (p < 0.001). The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 (95% CI: 0.094-0.136) to 0.082 (0.073-0.092) events per person per year in type 1 diabetes (p < 0.001), and from 0.118 (0.095-0.141) to 0.037 (0.003-0.041) in insulin-treated type 2 diabetes (p = 0.008). However, the absolute annual number of hypoglycemia events requiring emergency treatment was 1.4-fold higher.Conclusions: Although from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher (2.7 fold), the number of severe hypoglycemia events requiring emergency medical treatment was greater.

KW - Diabetes

KW - Hypoglycemia

KW - Emergency medical care

KW - Insulin

KW - Sulfonylurea

U2 - 10.1186/s40842-017-0045-0

DO - 10.1186/s40842-017-0045-0

M3 - Article

VL - 3

SP - 1

EP - 8

JO - Clinical Diabetes and Endocrinology

JF - Clinical Diabetes and Endocrinology

SN - 2055-8260

M1 - 7

ER -