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Hospitalization and Discharge Education of Emergency Department Patients With Hypoglycemia

From the Department of Emergency Medicine, University of Colorado Health Sciences Center, Aurora, Colorado (Dr Ginde), Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Ginde), Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts (Dr Pallin), and Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (Dr Camargo).

Correspondence to Adit A. Ginde, MD, MPH, University of Colorado Health Sciences Center, Department of Emergency Medicine, Leprino Office Building, 7th Floor, 12401 E. 17th Avenue, B-215, Aurora, CO 80045 (adit.ginde{at}uchsc.edu).

Purpose

The purpose of this study is to evaluate the content and adequacy of emergency department (ED) discharge instructions and factors associated with hospitalization in patients presenting with hypoglycemia.

Methods

This is a retrospective cohort study at 3 adult EDs. A 1-year consecutive sample of hypoglycemia cases were identified using ICD-9-CM codes and were confirmed by chart review. Clinical variables and written discharge instructions were analyzed by chart abstraction.

Results

Six hundred thirty-six charts of patients with possible hypoglycemia were reviewed, of which 436 (64%) hypoglycemia cases were confirmed. The median age was 64. Hypoglycemia was associated with sulfonylurea use for 78 (16%) patients and insulin alone for 286 (65%) patients. Written discharge instructions advised frequent blood glucose checks in 21% of patients and medication dose adjustment in 27% of patients and rarely recommended avoiding recurrent hypoglycemia (3%), checking glucose before driving (0.4%), or obtaining glucagon emergency kits (2%). Hospitalization resulted from 177 (41%) visits and was associated with older age (age 65-74 [odds ratio 5.7] and age 75 [odds ratio 7.9]), sulfonylurea use (odds ratio 3.5), 3 hypoglycemic episodes (odds ratio 3.1), no documented diabetes medications (odds ratio 2.1), current primary care provider (odds ratio 4.2), and hypoglycemia as a secondary diagnosis (odds ratio 4.7).

Conclusions

ED written discharge instructions appeared inadequate in providing recommended education for patients with severe hypoglycemia. Older age and sulfonylurea use were independently associated with hospital admission. Although hypoglycemia is generally considered a self-limited condition, 2 of every 5 patients required hospitalization, which likely reflects an older and more complex patient population.

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