Predictors of Glycemic Emergencies in Patients with Type 1 Diabetes

Presentation Number: MON 631
Date of Presentation: April 3rd, 2017

Sarah Monsonego*1, Mary-Anne Doyle2, Martha Carruthers3 and Janine Charisse Malcolm2
1University of Ottawa, Ottawa, ON, CANADA, 2University of Ottawa, Ottawa, ON, Canada, 3University of Toronto

Abstract

Background and Objectives: Individuals with type 1 diabetes (T1DM) are at risk of developing acute life threatening emergenices such as diabetic ketoacidosis and severe hypoglycemic episodes. These complications are associated with severe morbidity and increased healthcare utilization. These emergencies are theoretically preventable with the identification of at risk patients and the application of risk reducing strategies. The objectives of this study were to describe the clinical characteristics of adult patients with T1DM who presented with a diabetic emergency and to identify opportunities for risk reduction.

Methods: We performed a retrospective analysis of patients who presented to the emergency department at The Ottawa Hospital (TOH), a tertiary care academic hospital, with a serious hyperglycemic or hypoglycemic event between March 2012 and February 2014.

Results: Based on discharge diagnosis, 161 hyperglycemic events and 133 hypoglycemic events were identified. The patients presenting with hyperglycemic emergencies were primarily female (53%), had a mean age of 34 (+/-16), and a mean A1C of 10.6% (+/-1.8). In contrast, patients with a hypoglycemic event were primarily male (64%), were slightly older with a mean age of 44 (+/-17) and had a lower mean A1C [8.1% (+/-1.7)]. While a high percentage of patients in both groups were on MDI (hyperglycemia 78% vs hypoglycemia 82%, p=0.44), patients in the hypoglycemic group were more likely to have had diabetes for > 5 years (hyperglycemia 50% and hypoglycemia 87% , p<0.001)]. The majority of patients had an endocrinologist, however a large proportion of patients in both groups (hyperglycemia 37% vs hypoglycemia 59%) were not seen in the diabetes clinic in the year prior to the event. Recurrent events within a year were more common in the hyperglycemic group (hyperglycemia 48% vs hypoglycemia 32%, p<0.001). There was a lack of outpatient follow-up post-discharge among patients in both groups with this being more significant in the hypoglycemic group (41% vs 22%, p<0.001).

Conclusion: Glycemic emergencies are serious yet preventable events in patients with T1DM. Patients presenting with hyperglycemic emergencies had different clinical characteristics than those presenting with hypoglycemic emergencies. However, both groups shared common high-risk features including longstanding diabetes, and suboptimal glycemic control. The high rate of recurrence and low rate of diabetes clinic visits in both groups demonstrates suboptimal contact with diabetes care providers and possible gaps in self management. This study highlights the importance of identifying at risk patients and understanding the challenges associated with diabetes follow up which will help to guide the development of risk-reducing education tools and strategies.

 

Nothing to Disclose: SM, MAD, MC, JCM