Hospitalization and discharge education of emergency department patients with hypoglycemia.

PURPOSE: The purpose of this study is to evaluate the content and adequacy of emergency department (ED) discharge instructions and factors associated with hospitalization in patients presenting with hypoglycemia.

METHODS: This is a retrospective cohort study at 3 adult EDs. A 1-year consecutive sample of hypoglycemia cases were identified using ICD-9-CM codes and were confirmed by chart review. Clinical variables and written discharge instructions were analyzed by chart abstraction.

RESULTS: Six hundred thirty-six charts of patients with possible hypoglycemia were reviewed, of which 436 (64%) hypoglycemia cases were confirmed. The median age was 64. Hypoglycemia was associated with sulfonylurea use for 78 (16%) patients and insulin alone for 286 (65%) patients. Written discharge instructions advised frequent blood glucose checks in 21% of patients and medication dose adjustment in 27% of patients and rarely recommended avoiding recurrent hypoglycemia (3%), checking glucose before driving (0.4%), or obtaining glucagon emergency kits (2%). Hospitalization resulted from 177 (41%) visits and was associated with older age (age 65-74 [odds ratio 5.7] and age >or=75 [odds ratio 7.9]), sulfonylurea use (odds ratio 3.5), >or=3 hypoglycemic episodes (odds ratio 3.1), no documented diabetes medications (odds ratio 2.1), current primary care provider (odds ratio 4.2), and hypoglycemia as a secondary diagnosis (odds ratio 4.7).

CONCLUSIONS: ED written discharge instructions appeared inadequate in providing recommended education for patients with severe hypoglycemia. Older age and sulfonylurea use were independently associated with hospital admission. Although hypoglycemia is generally considered a self-limited condition, 2 of every 5 patients required hospitalization, which likely reflects an older and more complex patient population.