美国中西部上地区域的紧急医疗服务治疗严重低血糖症的管理和结果。
Management and Outcomes of Severe Hypoglycemia Treated by Emergency Medical Services in the U.S. Upper Midwest.
机构信息
Mayo Clinic Ambulance Service, Rochester, MN.
Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
出版信息
Diabetes Care. 2022 Aug 1;45(8):1788-1798. doi: 10.2337/dc21-1811.
OBJECTIVE
To examine factors associated with emergency department (ED) transport after hypoglycemia treated by emergency medical services (EMS) and assess the impact of ED transport on severe hypoglycemia recurrence.
RESEARCH DESIGN AND METHODS
We retrospectively analyzed electronic health records of a multistate advanced life support EMS provider and an integrated healthcare delivery system serving an overlapping geographic area in the upper Midwest. For adults with diabetes treated by EMS for hypoglycemia between 2013 and 2019, we examined rates of ED transport, factors associated with it, and its impact on rates of recurrent hypoglycemia requiring EMS, ED, or hospital care within 3, 7, and 30 days.
RESULTS
We identified 1,977 hypoglycemia-related EMS encounters among 1,028 adults with diabetes (mean age 63.5 years [SD 17.7], 55.2% male, 87.4% non-Hispanic White, 42.4% rural residents, and 25.6% with type 1 diabetes), of which 46.4% resulted in ED transport (31.1% of calls by patients with type 1 diabetes and 58.0% of calls by patients with type 2 diabetes). Odds of ED transport were lower in patients with type 1 diabetes (odds ratio [OR] 0.44 [95% CI 0.31-0.62] vs. type 2 diabetes) and higher in patients with prior ED visits (OR 1.38 [95% CI 1.03-1.85]). Within 3, 7, and 30 days, transported patients experienced recurrent severe hypoglycemia 2.8, 5.2, and 10.6% of the time, respectively, compared with 7.4, 11.2, and 22.8% of the time among nontransported patients (all P < 0.001). This corresponds to OR 0.58 (95% CI 0.42-0.80) for recurrent severe hypoglycemia within 30 days for transported versus nontransported patients. When subset by diabetes type, odds of recurrent severe hypoglycemia among transported patients were 0.64 (95% CI 0.43-0.96) and 0.42 (95% CI 0.24-0.75) in type 1 and type 2 diabetes, respectively.
CONCLUSIONS
Transported patients experienced recurrent hypoglycemia requiring medical attention approximately half as often as nontransported patients, reinforcing the importance of engaging patients in follow-up to prevent recurrent events.
目的
探讨与接受急救医疗服务（EMS）治疗的低血糖后转入急诊科（ED）相关的因素，并评估 ED 转运对严重低血糖复发的影响。
研究设计和方法
我们回顾性分析了一家多州高级生命支持 EMS 供应商和一家综合性医疗服务提供系统的电子健康记录，这两个系统服务于中西部上半岛的重叠地理区域。对于在 2013 年至 2019 年间因低血糖接受 EMS 治疗的成年糖尿病患者，我们检查了 ED 转运的比例、与转运相关的因素，以及其对 3、7 和 30 天内需要 EMS、ED 或住院治疗的复发性低血糖的影响。
结果
我们从 1028 名糖尿病成人中确定了 1977 例低血糖相关的 EMS 就诊（平均年龄 63.5 岁[SD 17.7]，55.2%为男性，87.4%为非西班牙裔白人，42.4%为农村居民，25.6%为 1 型糖尿病患者），其中 46.4%需要 ED 转运（1 型糖尿病患者的转运比例为 31.1%，2 型糖尿病患者的转运比例为 58.0%）。1 型糖尿病患者（比值比 [OR] 0.44 [95%置信区间 0.31-0.62]与 2 型糖尿病患者相比）ED 转运的可能性较低，而既往 ED 就诊患者（OR 1.38 [95%置信区间 1.03-1.85]）的可能性较高。在 3、7 和 30 天内，转运患者分别有 2.8%、5.2%和 10.6%的时间发生复发性严重低血糖，而非转运患者分别有 7.4%、11.2%和 22.8%的时间发生复发性严重低血糖（所有 P < 0.001）。这相当于转运患者与非转运患者相比，30 天内复发性严重低血糖的 OR 为 0.58（95% CI 0.42-0.80）。当按糖尿病类型进行亚组分析时，转运患者中 1 型和 2 型糖尿病患者的复发性严重低血糖的可能性分别为 0.64（95% CI 0.43-0.96）和 0.42（95% CI 0.24-0.75）。
结论
转运患者经历需要医疗关注的复发性低血糖的可能性大约是未转运患者的一半，这进一步强调了让患者参与随访以预防再次发生事件的重要性。
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