Optimization of anti diabetic treatment and Patient education prevents emergency glycemic crisis in diabetes patients

A new study published in the Medicine Journal suggests optimization of anti-diabetic therapy and education of patients to avoid acute glycemic crises and physicians must be aware of the underlying causes (interrupted treatment) of acute glycemic crises and provide appropriate management

Despite advances in the treatment of diabetes mellitus (DM), severe acute glycemic crises still occur and are associated with high morbidity and mortality rates. In this study, Keisuke Endo and peers investigated the characteristics of patients who were transported to an emergency department due to acute glycemic crises.

The study enrolled patients who were transported by ambulance to a hospital due to hypoglycemia or hyperglycemia between January 2015 and December 2019. Patients with initial glucose levels below 70 mg/dL and above 250 mg/dL were defined as having hypoglycemia and hyperglycemia, respectively.

During the five-year study period, 16,910 patients were transported to the hospital by ambulance. Of these patients, 87 (0.51%) were diagnosed with hypoglycemia, 26 (0.15%) were diagnosed with hyperglycemia, and 1 patient was diagnosed with lactic acidosis.

Patients with hyperglycemia were younger, more likely to be hospitalized, and had a poorer prognosis than those with hypoglycemia. The main reasons for hyperglycemia were interrupted treatment, forgetting insulin injection, and infection.

The study revealed that the main causes of hypoglycemia in non-DM patients were excessive alcohol intake and malnutrition.

In DM patients with hypoglycemia, inappropriate medication was often used. The blood urea nitrogen, serum potassium, and hemoglobin levels were higher in patients with hyperglycemia, whereas the systolic blood pressure was lower and the pulse rate was higher in patients with hyperglycemia.

This study highlights the importance of identifying the underlying causes of acute glycemic crises and optimizing anti-DM therapy to avoid their occurrence. Furthermore, patients should be educated on how to recognize the symptoms of hypoglycemia and hyperglycemia, how to monitor their glucose levels, and how to manage their medication properly.

Source:

Endo, K., Itoh, T., Tanno, M., Ohno, K., Hotta, H., Kato, N., Matsumoto, T., Ooiwa, H., Kubo, H., & Miki, T. (2021). Characteristics of patients with emergency attendance for severe hypoglycemia and hyperglycemia in a general hospital in Japan. In Medicine (Vol. 100, Issue 25, p. e26505). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/md.0000000000026505