Summary

Hypoglycemia in Spanish emergency departments: current situation and prospects

Pablo Matías Soler¹, Luis Picazo García², Ricardo Mesanza Forés³, Marina Gil Mosquera¹, Laura de Pedro Álvarez⁴, Arturo Corbatón Anchuelo^1,5, Laura Mariel Matus⁶, Ricardo Muñoz Albert⁷, María Ángeles San Martín Díez⁸, Ainhona Burzaco Sánchez⁸, Aitor Odiaga Andicoechea⁹, Andreaa Irimia¹⁰, Rosana Soriano Barrón¹¹, Esther Ruescas Esculano¹², Mireia Cramp Vinaixa¹³, Fahd Beddar Chaib¹⁴, Esther Álvarez Rodríguez¹⁵, Beatriz Mañero Criado¹⁶

Affiliation of the authors

¹Servicio de Urgencias y Fundación para la Investigación Biomédica (IDISSC). Hospital Clínico San Carlos, Madrid, Spain. ²Servicio Emergencias Extrahospitalarias de Valencia. Spain. ³Servicio de Urgencias, Hospital de Getafe, Madrid, Spain. ⁴Servicio de Urgencias. Hospital Doce de Octubre, Madrid, Spain. ⁵Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain. ⁶Servicio de Urgencias, Hospital de Fuenlabrada, Madrid, Spain. ⁷Servicio de Urgencias, Hospital de La Ribera, Valencia, Spain. ⁸Servicio de Urgencias, Hospital de Cruces, Barakaldo, Vizcaya, Spain. ⁹Servicio de Urgencias, Hospital de Galdakao y Gernika, Vizcaya, Spain. ¹⁰Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain. ¹¹Servicio de Urgencias, Hospital San Pedro de Logroño, Spain. ¹²Servicio de Urgencias, Hospital de Vinalopó, Alicante, Spain. ¹³Servicio de Urgencias, Hospital Joan XXIII, Tarragona, Spain. ¹⁴Servicio de Urgencias, Hospital Santa Bárbara de Soria, Spain. ¹⁵Servicio de Urgencias, Hospital de Leganés, Madrid, Spain. ¹⁶Servicio de Urgencias, Hospital La Paz, Madrid, Spain.

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Matías Soler P, Picazo García L, Mesanza Forés R, Gil Mosquera M, de Pedro Álvarez L, Corbatón Anchuelo A, Mariel Matus L, Muñoz Albert R, San Martín Díez MA, Burzaco Sánchez A, Odiaga Andicoechea A, Irimia A, Soriano Barrón R, Ruescas Esculano E, Cramp Vinaixa M, Beddar Chaib F, Álvarez Rodríguez E, Mañero Criado B. Hypoglycemia in Spanish emergency departments: current situation and prospects. Rev Esp Urg Emerg. 2025;4:07–14

Summary

OBJECTIVE. To describe the characteristics of patients attended for hypoglycemia in emergency departments (EDs), the causes of hypoglycemic episodes, and treatments prescribed. To evaluate adherence to the consensus-based treatment guidelines issued by Spanish scientific associations.
METHODS. Retrospective multicenter cohort study of cases treated in 11 Spanish hospitals (3, tertiary care; 8, secondary care). We reviewed records for patients over the age of 18 years attended for hypoglycemia in EDs between July 1, 2018, and July 31, 2019. Multiple logistic regression analyses were performed.
RESULTS. A total of 978 patients (51.1%, men) were included. The median age was 73.3 years. The median hospital stay was 1 day; 90.3% of the patients had diabetes (82.3%, type 2), and 76.9% had a Charlson Comorbidity Index of 3 or higher. Insulin was the antidiabetic treatment the majority (72.6%) were using. Inadequate caloric intake was the most common cause of hypoglycemia (in 29.8%). A dextrose solution (5% or 10%) was used to correct hypoglycemia in 58.7%. Treatment in acute cases of hypoglycemia followed protocols in 36.2% of the ED cases; at discharge, treatment protocols were followed in 50.5% of cases. ED revisits were recorded for 23.6% at 30 days and for 36.8% at 90 days. Metabolic decompensation accounted for 26% of revisits within 30 days and 23% within 90 days. The 30-day and 90-day mortality rates were 6.7% and 8.9%, respectively. Hazard ratios (HRs) indicated that adherence to established protocols on discharge was associated with lower probability of ED revisiting at 30 days and 90 days, respectively, as follows: HR 0.45 (95% CI, 0.35-0.58) and HR 0.37 (95% CI, 0.26-0.53) for all-cause revisits; and HR 0.37 (95% CI, 0.19-0.72) and HR 0.44 (95% CI, 0.26-0.74) for revisits related to metabolic decompensation.
CONCLUSIONS. The most common profile of patients treated for hypoglycemia in EDs is a frail person of advanced age with type-2 diabetes under treatment with insulin. Inadequate caloric intake is the most common cause of hypoglycemic emergencies. Emergency physicians’ adherence to established protocols for treating hypoglycemia is low. Adherence to protocols for prescribing antidiabetic treatment at discharge is also low. Adherence is an independent factor that reduces the frequency of revisits, either for all causes or for metabolic decompensation.