• Brian H Rowe, Mira Singh, Cristina Villa-Roel, Lawrence A Leiter, Irene Hramiak, Marcia L Edmonds, Eddy Lang, Marco Sivilotti, Frank Scheuermeyer, Andrew Worster, Jennifer Riley, Marc Afilalo, Ian Stiell, Jean-Francois Yale, Vincent C Woo, Samuel Campbell, and Canadian Association of Emergency Physicians Research Consortium.
• Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Electronic address: brian.rowe@ualberta.ca.
• Can J Diabetes. 2015 Feb 1; 39 (1): 55-64.

ObjectivesThis retrospective chart audit examined the demographics, investigations, management and outcomes of adult patients with diabetes mellitus presenting to Canadian emergency departments (EDs).MethodsAll sites conducted a search of their electronic medical records using International Classification of Diseases, Tenth Revision, codes to identify ED visits for hypoglycemia between 2008 and 2010. Patient characteristics, demographics, ED management, ED resources and outcome are reported.ResultsA total of 1039 patients over the age of 17 years were included in the study; 347 (33.4%) were classified as type 1 diabetes and 692 (66.6%) were classified as type 2 diabetes. Type 2 diabetes patients were significantly older (73 vs. 49 years; p<0.0001) and had more chronic conditions recorded on their chart (all p<0.001). Most subjects arrived by ambulance, and triage scores revealed severe presentations in 39% of cases. Treatments for hypoglycemia were common (75.7%) during prehospital transport; 38.5% received intravenous glucose and 40.1% received glucagon. Hypoglycemia treatments in the ED included oral (76.8%), intravenous (29.6%) and continuous infusion (27.7%) of glucose. Diagnostic testing (81.9%) commonly included electrocardiograms (51.9%), chest radiography (37.5%) and head computed tomography scans (14.5%). Most patients (73.5%) were discharged; however, more subjects with type 2 diabetes required admission (30.3 vs. 8.8%). Discharge instructions were documented in only 55.5% of patients, and referral to diabetes services occurred in fewer than 20% of cases. Considerable variation existed in the management of hypoglycemia across EDs.ConclusionsPatients with diabetes presenting to an ED with hypoglycemia consume considerable healthcare resources, and practice variation exists. Emergency departments should develop protocols for the management of hypoglycemia, with attention to discharge planning to reduce recurrence.Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

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