News & Commentary

Insulin Misusers Flood Hospital EDs

It’s not exactly a matter of the cure being worse than the disease, but recent findings about diabetes and emergency department (ED) visits should at least give policymakers and clinicians pause.

The findings also ask: Just how should patients with diabetes who are 80 and over be managed?

Nearly 100,000 people wound up in the ED over five years because of mistakes made in diabetes treatment, most of it self-treatment, according to researchers at the Centers for Disease Control and Prevention. Those visits may have cost “well over” $600 million.

As the name suggests, the study in JAMA Internal Medicine, “National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations,” looks at insulin-related hypoglycemia and errors (IHEs). The study took place from January 2007 through December 2011.

Patients ages 80 or older were more than twice as likely to head to the ED for IHEs as those 65 to 79, according to the study.

“Patients in the oldest group were also almost five times as likely to be hospitalized for IHEs as those 45 to 64 years,” the study states.

There were about 30,000 IHE-related hospitalizations in the five years.

Researchers point out that guidelines from such organizations as the American Geriatrics Society say that medications shouldn’t be used to achieve hemoglobin HbA1c control in most adults ages 65 or older.

The study states that “the high frequency and severity of ED visits for IHEs suggest careful consideration of hypoglycemic sequelae and a cautious approach when deciding whether to start or intensify insulin treatment among older adults, especially the very elderly.”

Of course, diabetes has everything to do with eating.

“Although meal planning is a well-recognized component of diabetes self-management education, the most commonly documented IHE precipitant in this study was meal-related misadventure, suggesting that further emphasis on meal planning in diabetes patient education efforts may be needed.”

The problem might very well be worse than the study suggests because “hypoglycemia, although a frequent cause of emergency medical service calls, is most often cared for outside the ED. Patients who have hypoglycemia unawareness and whose episodes do not result in EMS or ED care are not counted, nor are those who died en route or in the ED.”

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