Authors: Jiménez-Montero JG, Hernández-Saborío I, Cob-Sánchez A.
Objective: To report the frequency of severe hypoglycemic events (SHGE) admitted into the Emergency Department (ED) of Hospital San Juan de Dios.
Methods: We recorded demographic, clinical characteristics, finger-stick glucose level, co-morbidities and length of stay of diabetics treated with anti-hyperglycemic agents suffering SHGE. Healthcare costs linked to admission into ED with SHGE were assessed.
Results: From March to July 2018, 55620 patients were attended at the ED. Of them, 4434 had non-communicable conditions including 961 diabetics, of those 61 had SHGE. Females (n = 37, aged 70 ± 16.01 yo) and males (n = 24, aged 62.9 ± 13.4 yo) (mean ± SD) constitute the study population. The reported co-morbidities were: cardiovascular disease (16.3 %), cerebrovascular disease (11.4 %), renal disease (19.6%) and chronic liver disease (1.6 %). In females finger-stick glucose level was 42 ± 15.44 mg/dl and in males 32.6 ± 8.8 mg/dL (mean ± SD, p=ns). Four patients had 2 episodes of SHGE and another patient presented seizures. SHGE was associated with insulin in 56 patients, 2 cases associated to glibenclamide and in three the medication was unknown. Of those on insulin, 22 also received metformin. All received IV dextrose and none required hospitalization. The length of stay in ED was 3.46 ± 5.3 hours. The costs per patient Ìs visits were 693 ± 303 dollars representing an overall cost of 42.3000 US dollars. Patient`s costs due to loss of working hours were not evaluated.
Discussion: This is the first study, which explores the significance of SHGE in the ED of a tertiary hospital in Costa Rica. Recurrent and severe hypoglycemia could trigger future cardiovascular events and aggravates cognitive dysfunction in elderly diabetics.
Conclusion: Hypoglycemia represents an unexplored complication associated to diabetes treatment in Costa Rica. Better ambulatory glycemic anagement and evaluation of current pharmacologic approaches is recommended in this country.
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