Endocrine Abstracts

Background: Severe hypoglycemia, marked by blood glucose levels below 3 mmol/l (level 2) or necessitating third-party assistance (level 3), poses a significant risk leading to unplanned hospital admissions in individuals with diabetes. However, there is a paucity of information on admitted patients’ characteristics, management, and outcomes.

Objective: To explore the characteristics of the population, precipitating factors and outcomes of people admitted with either level 2 or 3 hypoglycemia.

Methods: This retrospective study was conducted from October 2023 to January 2024 across five hospitals in the UK. All adults aged>18 years admitted to hospitals with either level 2 or level 3 hypoglycaemia from November 2022 to October 2023 were included in the study. Various data on sociodemographics, precipitating factors, management and outcomes were collected. Data was analysed on SPSS 29.0.

Results: We identified 222 episodes of severe hypoglycemia, with 160 occurrences in individuals with type 2 diabetes and 62 in those with type 1 diabetes. Among these episodes, 158 were classified as level 2 (110 in type 2 and 48 in type 1), while 64 were categorised as level 3 (50 in type 2 and 14 in type 1). 22.5% of individuals with type 2 diabetes had received insulin treatment before admission. The median (interquartile) age was 44.5 (40.0-64.3) and 80.0 (70.0-83.0) years for people with type 1 and type 2 diabetes, respectively. Their Charlson comorbidity index was 4 (2-6) and 7 (6-8) respectively. The primary precipitating factor for hypoglycemia was a missed meal, accounting for 58.8% of type 2 and 45.2% of type 1 diabetes cases. Furthermore, 17.7% of people with type 1 diabetes and 12.5% with type 2 diabetes received glucagon either at home, in an ambulance, or upon admission. However, only 2.7% (6/222) of individuals (6.5% (4/62) with type 1 diabetes and 1.3% (2/160) with type 2 diabetes) were prescribed glucagon upon discharge. Insulin dose reduction emerged as the most common therapeutic adjustment on discharge, with 111 cases overall (31 in type 1 and 80 in type 2). Additionally, 11.3% of type 1 and 2.5% of type 2 diabetes cases commenced continuous glucose monitoring (CGM) upon discharge for timely alerts and prevention of further hypoglycemic events.

Conclusion: Individuals requiring hospitalisation for severe hypoglycemia were typically elderly and frail, often due to missed meals. Despite glucagon needs during episodes, prescriptions upon discharge were infrequent. These findings underscore the need for targeted educational interventions to mitigate such occurrences.