High rate of ED visits for insulin-related hypoglycemia

ST LOUIS - Insulin-related hypoglycemia and errors (IHEs) account for close to 100,000 emergency department (ED) visits per year in the United States, according to a study published online by JAMA Internal Medicine. The researchers sought to estimate the burden, rates, and characteristics of ED visits for IHEs, including identification of high-risk groups and precipitating factors. The analysis included National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project data from 1997 through 2011, along with a national household survey of insulin use. The lead author was Dr Andrew I. Geller of the Centers for Disease Control and Prevention. Based on 8,100 cases identified from the adverse drug event surveillance database, the annual number of ED visits for IHEs was estimated at 97,648. Of these, 29.4% led to hospitalization and 60.6% were associated with severe neurologic sequelae. Blood glucose levels of 50 mg/dL or less were recorded in 53.4% of events. Patients aged 80 years older were at highest risk of ED visits for IHEs, rate ratio 2.5; and at highest risk for hospitalization, rate ratio 4.9 (compared to patients aged 45 to 64). The main precipitating factors were inadequate food intake and taking the wrong type of insulin. Recent reports have drawn attention to the potential for harmful effects of tight glycemic control with insulin in patients with type 2 diabetes. One important risk is insulin-related hypoglycemia, particularly in groups of patients who are less likely to benefit from tight control. This study identifies IHEs as an important cause of ED visits and hospitalizations, especially in diabetic patients aged 80 years and older. Of the nearly 100,000 annual ED visits for IHEs, 60,000 lead to severe neurologic sequelae and almost 30 000 to hospitalization. Efforts to reduce this risk should focus on the precipitating factors identified, such as "meal-related misadventures and insulin product mix-ups."