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Endocrine Abstracts (2023) 90 EP236 | DOI: 10.1530/endoabs.90.EP236

1Hospital Universitario Virgen Macarena, Endocrinology and Nutrition, Sevilla, Spain; 2Virgen del Rocío University Hospital, Endocrinology and Nutrition, Sevilla, Spain; 3Hospital Regional Universitario de Málaga, Endocrinology and Nutrition, Málaga, Spain; 4Hospital Universitario Reina Sofia, Endocrinology and Nutrition, Córdoba, Spain; 5Hospital Universitario Virgen de la Victoria, Endocrinology and Nutrition, Málaga, Spain; 6Hospital Universitario Puerta del Mar, Endocrinology and Nutrition, Cádiz, Spain; 7Virgen de las Nieves University Hospital, Endocrinology and Nutrition, Granada, Spain; 8Hospital Universitario Nuestra Señora de Valme, Endocrinology and Nutrition, Sevilla, Spain; 9Hospital Universitario De Jerez, Endocrinology and Nutrition, Jerez de la Frontera, Spain; 10University Hospital of Puerto Real, Endocrinology and Nutrition, Puerto Real, Spain; 11Hospital Universitario Juan Ramón Jiménez, Endocrinology and Nutrition, Huelva, Spain; 12Hospital Cabra, Internal Medicine, Cabra, Spain; 13Torrecárdenas University Hospital, Endocrinology and Nutrition, Almería, Spain; 14Hospital Universitario Clínico San Cecilio, Endocrinology and Nutrition, Granada, Spain; 15Hospital of Jaen, Endocrinology and Nutrition, Jaén, Spain; 16EPES 061, Puerto Real, Spain

Objectives: To describe modifiable sociodemographic and clinical risk factors predictive of severe hypoglycemia with need for urgent health care in adults with type 1 diabetes (T1DM).

Methods: Multicenter, observational and retrospective study with case-control design.

Cases: T1DM adults with severe hypoglycemia, defined as glycemia <70 mg/dl requiring urgent out-of-hospital health care for its resolution. Data source, geographical and temporal framework: cases selected from the register of care contacts of the Public Emergency Company of Andalusia (PECA) throughout the territorial scope of the Andalusian Public Health System (APHS), during the period 2018-2020.

Controls: Adults with T1DM without a history of severe hypoglycemia. Selected with 1:1 ratio, matched by basic variables: sex, age, reference health area, glycemic monitoring method and insulin administration system (multiple doses/insulin pumps).

Results: A total of 389 participants were included (219 cases and 170 controls) from a total of 16 reference hospitals in Andalusia (Spain). The mean age of the cases was 46.4 years (SD 14.2), with 57.5% male. The most frequent cause of severe hypoglycemia was an error in rapid insulin dosing (33.8%). In 15.6% of the cases, evacuation to a health center was required for resolution. More than one severe hypoglycemia event was recorded during the study period (2018-20) in 35.5%. In 18.9% of cases used interstitial flash glucose monitoring systems at the time of severe hypoglycemia, and 3.8% were users of insulin pumps. Among the psychosocial variables, a higher prevalence of depression (17.7% vs 7.1%, P=0.007), physical and/or intellectual disability (9% vs 3%, P=0.04) and lack of university or technical education (59.7% vs 36.8%, P=0.002) was observed in the group of cases. In relation to the natural history of T1DM, the time of evolution was longer in cases compared to controls (27.9 vs 23 years, P=0.008), as well as the prevalence of chronic complications (proliferative retinopathy 16.8% vs 6.3%, P=0.007; vascular-cerebral accident 6.2% vs 0.8%, P=0.01) and of NO follow-up in endocrinology units (14.2% vs 7%, P=0.04). The previous history of severe hypoglycemia was significantly higher in the case group, both in the overall follow-up history and in the last year (respectively: 56.4% vs 16.5%, P<0.001; 34.5% vs 1.6%, P<0.001). Also higher in cases was the prevalence of nocturnal hypoglycemia (56% vs 26.9%, P<0.001) and of inadvertent hypoglycemia (61.6% vs 21.2%, P<0.001).

Conclusions: Chronic diabetes-related complications, history of severe hypoglycemia, nocturnal hypoglycemia and inadvertent hypoglycemia, as well as depression, dependency status and low academic education level are risk factors for severe hypoglycemia in T1DM. These variables could be incorporated into strategies for identifying patients at risk and designing specific preventive interventions based on diabetes education.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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