Characteristics and costs of individuals experiencing severe hypoglycaemia requiring emergency ambulance assistance in the community

Khunti, Kamlesh and Fisher, Harriet and Paul, Sanjoy and Iqbal, Mohammad and Davies, Melanie J. and Siriwardena, A. Niroshan (2012) Characteristics and costs of individuals experiencing severe hypoglycaemia requiring emergency ambulance assistance in the community. In: 48th European Association for the Study of Diabetes (EASD) Annual Meeting, 2-5 October 2012, Berlin, Germany.

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Characteristics and costs of individuals experiencing severe hypoglycaemia requiring emergency ambulance assistance in the community
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Abstract

Background and aims: Hypoglycaemia causes considerable a burden to individuals the healthcare providers. The aim of this study was to examine clinical characteristics of individuals requiring emergency medical assistance by ambulance services for an episode of severe hypoglycaemia and to estimate provider costs of hypoglycaemia.
Materials and methods: Routinely collected information was retrieved for all episodes of severe hypoglycaemia attended to by the emergency ambulance services for a population of 367,051 people, including 75,603 people with diabetes, in Nottinghamshire and Derbyshire, UK, between 01/11/10 to 28/02/11. A total of 90,435 emergency calls were received in the study period, of which 523 (0.6%) were recorded as severe hypoglycaemia. The time to response, on-site treatment and hospitalisation were recorded along with standard clinical and blood glucose (BG) measures. Ambulance services costs were calculated.
Results: The mean (SD) [proportion <= 3.2 mmol/L] pre and post-treatment BG levels were 1.9 (0.9) mmol/L [92%] and 6.5 (3.1) mmol/L [3%] respectively, 74% were under insulin treatment, 28% had nocturnal hypoglycaemia, and 153 (32%) individuals were transported to hospital. Lower pre-treatment BG (p<0.01) and Glasgow Coma Scale scores (p=0.05) were observed in insulin treated individuals in comparison to non-insulin treated individuals. No significant differences in individual characteristics were observed for other clinical measurements: post-treatment blood glucose (p=0.39), systolic blood pressure (p=0.28), diastolic blood pressure (p=0.64) and heart rate (p=0.93). Non insulin treatment was an independent predictor of transportation to hospital (p<0.01). Median time from allocation of call to departure of scene by ambulance services was 39 and 59 minutes for those transported and not transported to hospital respectively, translating to costs of £92 and £139 respectively. The median time from allocation to handing over patients to emergency staff was 75 minutes, equating to a cost of £176.
Conclusion: The majority of cases of severe hypoglycaemia are successfully treated at the scene by the emergency ambulance services. Insulin treated and non insulin treated individuals do not differ by clinical characteristics, however non insulin treated individuals were more likely to be transported to hospital. Further studies are needed into the effect of prehospital ambulance care by treatment type on subsequent outcomes.

Item Type:Conference or Workshop Item (Poster)
Additional Information:Background and aims: Hypoglycaemia causes considerable a burden to individuals the healthcare providers. The aim of this study was to examine clinical characteristics of individuals requiring emergency medical assistance by ambulance services for an episode of severe hypoglycaemia and to estimate provider costs of hypoglycaemia. Materials and methods: Routinely collected information was retrieved for all episodes of severe hypoglycaemia attended to by the emergency ambulance services for a population of 367,051 people, including 75,603 people with diabetes, in Nottinghamshire and Derbyshire, UK, between 01/11/10 to 28/02/11. A total of 90,435 emergency calls were received in the study period, of which 523 (0.6%) were recorded as severe hypoglycaemia. The time to response, on-site treatment and hospitalisation were recorded along with standard clinical and blood glucose (BG) measures. Ambulance services costs were calculated. Results: The mean (SD) [proportion <= 3.2 mmol/L] pre and post-treatment BG levels were 1.9 (0.9) mmol/L [92%] and 6.5 (3.1) mmol/L [3%] respectively, 74% were under insulin treatment, 28% had nocturnal hypoglycaemia, and 153 (32%) individuals were transported to hospital. Lower pre-treatment BG (p<0.01) and Glasgow Coma Scale scores (p=0.05) were observed in insulin treated individuals in comparison to non-insulin treated individuals. No significant differences in individual characteristics were observed for other clinical measurements: post-treatment blood glucose (p=0.39), systolic blood pressure (p=0.28), diastolic blood pressure (p=0.64) and heart rate (p=0.93). Non insulin treatment was an independent predictor of transportation to hospital (p<0.01). Median time from allocation of call to departure of scene by ambulance services was 39 and 59 minutes for those transported and not transported to hospital respectively, translating to costs of £92 and £139 respectively. The median time from allocation to handing over patients to emergency staff was 75 minutes, equating to a cost of £176. Conclusion: The majority of cases of severe hypoglycaemia are successfully treated at the scene by the emergency ambulance services. Insulin treated and non insulin treated individuals do not differ by clinical characteristics, however non insulin treated individuals were more likely to be transported to hospital. Further studies are needed into the effect of prehospital ambulance care by treatment type on subsequent outcomes.
Keywords:Emergency Medical Systems, ambulance services, hypoglycaemia, diabetes mellitus, cost analysis, cross sectional study
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
ID Code:6252
Deposited By: Niro Siriwardena
Deposited On:26 Sep 2012 13:40
Last Modified:13 Mar 2013 09:14

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