Sílvia Alão1, João Conceição2, Jorge Dores3, Lèlita Santos4,5, Francisco Araújo6, Estevão Pape7, Mónica Reis8, Árcia Chipepo6, Edite Nascimento9, Ana Baptista10, Vanessa Pires11, Carlos Marques12, Adriana De Sousa Lages4, João Pelicano-Romano13, Paula M de Jesus13. 1. MSD Portugal, R. Qta da Fonte 19, 2770-192, Paço de Arcos, Portugal. silvia.alao@merck.com. 2. MSD International GmbH (Singapore Branch), Medical Affairs, Singapore, Singapore. 3. Centro Hospitalar e Universitário do Porto, Porto, Portugal. 4. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 5. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal. 6. Beatriz Ângelo Hospital, Loures, Portugal. 7. Hospital Garcia de Orta, Almada, Portugal. 8. Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal. 9. Centro Hospitalar Tondela Viseu, Viseu, Portugal. 10. Centro Hospitalar Universitário do Algarve - Faro, Faro, Portugal. 11. Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal. 12. Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal. 13. MSD Portugal, R. Qta da Fonte 19, 2770-192, Paço de Arcos, Portugal.
Abstract
BACKGROUND: We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. METHODS: In this cross-sectional, multicentered study, the observational data was collected by physicians from patient's hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. RESULTS: There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). CONCLUSIONS: Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.
BACKGROUND: We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. METHODS: In this cross-sectional, multicentered study, the observational data was collected by physicians from patient's hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. RESULTS: There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DMpatients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). CONCLUSIONS: Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.
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Authors: João P Ferreira; Francisco Araújo; Jorge Dores; Lèlita Santos; Estevão Pape; Mónica Reis; Árcia Chipepo; Edite Nascimento; Ana Baptista; Vanessa Pires; Carlos Marques; Adriana S Lages; João Conceição; Pedro A Laires; João Pelicano-Romano; Sílvia Alão Journal: Diabetes Ther Date: 2020-07-11 Impact factor: 2.945