Increase in hypoglycemic admissions: California hospital discharge data.

Divisions of General Internal Medicine and Geriatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Ethnicity & disease (Impact Factor: 1.12). 01/2007; 17(3):536-40.
Source: PubMed

ABSTRACT To compare the percentage of diabetics admitted to the hospital due to hypoglycemia in 1990-1993 (period 1) to that in 1997-2000 (period 2).
We analyzed data from the California Hospital Discharge Data Program. Eligibility included diabetic (ICD code 250) subjects aged > or =25 years old who were hospitalized due to hypoglycemia (ICD Codes 250.8) during the periods 1990-1993 and 1997-2000. Data were analyzed by demographics and health insurance status.
Of the 2,905,091 hospitalized diabetics, 50,017 (1.7%) were due to hypoglycemia. The percentage of hospitalization due to hypoglycemic varied by sex, age, race/ethnicity, and insurance status (P = .0001). Male, Hispanic, age 25-64 years, with Medical/Medicare insurance had higher odds of being hospitalized due to hypoglycemia relative to other groups (P < .001). The percentage of diabetics hospitalized due to hypoglycemia increased from period 1 to period 2 (1.3% vs. 2.0%, P = .0001). Diabetics hospitalized in period 2 had higher adjusted odds of being hospitalized due to hypoglycemia relative to those admitted in period 1 (OR = 1.6, P < .0001).
Our data show an increase in the hospitalization due to hypoglycemia in diabetic patients. Enhanced patient education about self-monitoring of blood sugar and recognizing and treating the symptoms of hypoglycemia may help to minimize hypoglycemic hospitalizations.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: After adjusting for differences in demographics between the two populations, the study finds that people with diabetes incur healthcare costs approximately 2.4 times higher than people without diabetes. The authors also emphasize that because nearly one-third of the approximately 17 million people in the U.S. with diabetes remain undiagnosed, $132 billion represents a conservative estimate. Moreover, the prevalence of type 2 diabetes increases with age and is higher among certain racial and ethnic minority populations, which portends a substantial increase in incidence of the disease (and its associated costs) as the nation grows older and becomes more racially and ethnically diverse.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. To determine whether elderly patients admitted to hospital with specific drug toxicities were likely to have been prescribed an interacting drug in the week prior to admission. Three population-based, nested case-control studies. Ontario, Canada, from January 1, 1994, to December 31, 2000. All Ontario residents aged 66 years or older treated with glyburide, digoxin, or an angiotensin-converting enzyme (ACE) inhibitor. Case patients were those admitted to hospital for drug-related toxicity. Prescription records of cases were compared with those of controls (matched on age, sex, use of the same medication, and presence or absence of renal disease) for receipt of interacting medications (co-trimoxazole with glyburide, clarithromycin with digoxin, and potassium-sparing diuretics with ACE inhibitors). Odds ratio for association between hospital admission for drug toxicity (hypoglycemia, digoxin toxicity, or hyperkalemia, respectively) and use of an interacting medication in the preceding week, adjusted for diagnoses, receipt of other medications, the number of prescription drugs, and the number of hospital admissions in the year preceding the index date. During the 7-year study period, 909 elderly patients receiving glyburide were admitted with a diagnosis of hypoglycemia. In the primary analysis, those patients admitted for hypoglycemia were more than 6 times as likely to have been treated with co-trimoxazole in the previous week (adjusted odds ratio, 6.6; 95% confidence interval, 4.5-9.7). Patients admitted with digoxin toxicity (n = 1051) were about 12 times more likely to have been treated with clarithromycin (adjusted odds ratio, 11.7; 95% confidence interval, 7.5-18.2) in the previous week, and patients treated with ACE inhibitors admitted with a diagnosis of hyperkalemia (n = 523) were about 20 times more likely to have been treated with a potassium-sparing diuretic (adjusted odds ratio, 20.3; 95% confidence interval, 13.4-30.7) in the previous week. No increased risk of drug toxicity was found for drugs with similar indications but no known interactions (amoxicillin, cefuroxime, and indapamide, respectively). Many hospital admissions of elderly patients for drug toxicity occur after administration of a drug known to cause drug-drug interactions. Many of these interactions could have been avoided.
    JAMA The Journal of the American Medical Association 05/2003; 289(13):1652-8. · 29.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe hypoglycemia is a major problem for patients with type 1 diabetes and their relatives. The aim of this study was to compare patients' and relatives' assessments of rates of severe hypoglycemia and state of awareness and to explore the influence on involvement and concern of relatives. A cross-sectional paired questionnaire survey on hypoglycemia and the state of awareness was used in our study comprising 284 unselected adult patients with type 1 diabetes and their closest cohabitant. The cohabitant questionnaires also addressed involvement and concern. The agreement between assessments of rates of severe hypoglycemia and state of awareness made by patients and cohabitants was weak (kappa 0.404 and 0.442, respectively; P < 0.001). Cohabitants recalled more episodes of severe hypoglycemia than patients (2.7 vs. 1.6 episodes/patient-year; P < 0.001). Degree of involvement was positively related to the rate of severe hypoglycemia (P = 0.002) and negatively related to the state of awareness (P = 0.007) but not to level of HbA(1c), duration of diabetes, or presence of late complications, except for peripheral neuropathy (P = 0.01). Cohabitants of patients with type 1 diabetes recall significantly more episodes of severe hypoglycemia than the patients. The rate of severe hypoglycemia and state of hypoglycemic awareness are the principal determinants of degree of cohabitants' involvement in their partners' disease.
    Diabetes Care 04/2003; 26(4):1106-9. · 7.74 Impact Factor

Full-text (2 Sources)

Available from
May 16, 2014