OBJECTIVE To examine factors associated with emergency department (ED) transport after hypoglycemia treated by emergency medical services (EMS) and assess the impact of ED transport on severe hypoglycemia recurrence. RESEARCH DESIGN AND METHODS We retrospectively analyzed electronic health records of a multistate advanced life support EMS provider and an integrated healthcare delivery system serving an overlapping geographic area in the upper Midwest. For adults with diabetes treated by EMS for hypoglycemia between 2013 and 2019, we examined rates of ED transport, factors associated with it, and its impact on rates of recurrent hypoglycemia requiring EMS, ED, or hospital care within 3, 7, and 30 days. RESULTS We identified 1,977 hypoglycemia-related EMS encounters among 1,028 adults with diabetes (mean age 63.5 years [SD 17.7], 55.2% male, 87.4% non-Hispanic White, 42.4% rural residents, and 25.6% with type 1 diabetes), of which 46.4% resulted in ED transport (31.1% of calls by patients with type 1 diabetes and 58.0% of calls by patients with type 2 diabetes). Odds of ED transport were lower in patients with type 1 diabetes (odds ratio [OR] 0.44 [95% CI 0.31–0.62] vs. type 2 diabetes) and higher in patients with prior ED visits (OR 1.38 [95% CI 1.03–1.85]). Within 3, 7, and 30 days, transported patients experienced recurrent severe hypoglycemia 2.8, 5.2, and 10.6% of the time, respectively, compared with 7.4, 11.2, and 22.8% of the time among nontransported patients (all P < 0.001). This corresponds to OR 0.58 (95% CI 0.42–0.80) for recurrent severe hypoglycemia within 30 days for transported versus nontransported patients. When subset by diabetes type, odds of recurrent severe hypoglycemia among transported patients were 0.64 (95% CI 0.43–0.96) and 0.42 (95% CI 0.24–0.75) in type 1 and type 2 diabetes, respectively. CONCLUSIONS Transported patients experienced recurrent hypoglycemia requiring medical attention approximately half as often as nontransported patients, reinforcing the importance of engaging patients in follow-up to prevent recurrent events.

中文翻译：

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美国上中西部紧急医疗服务治疗的严重低血糖症的管理和结果

目的探讨急诊医疗服务 (EMS) 治疗低血糖后急诊科 (ED) 转运的相关因素，并评估 ED 转运对严重低血糖复发的影响。研究设 对于 2013 年至 2019 年期间因低血糖而接受 EMS 治疗的糖尿病成人，我们检查了 ED 转运率、相关因素及其对 3、7 和 30 天内需要 EMS、ED 或住院治疗的复发性低血糖发生率的影响. 结果 我们在 1,028 名糖尿病患者（平均年龄 63.5 岁 [SD 17.7]，55.2% 男性，87. 4% 非西班牙裔白人、42.4% 农村居民和 25.6% 患有 1 型糖尿病），其中 46.4% 导致 ED 转运（31.1% 的 1 型糖尿病患者呼叫和 58.0% 的 2 型糖尿病患者呼叫糖尿病）。1 型糖尿病患者的 ED 转运几率较低（几率比 [OR] 0.44 [95% CI 0.31–0.62] 与 2 型糖尿病患者相比），而在既往 ED 就诊的患者中转运几率更高（OR 1.38 [95% CI 1.03– 1.85]）。在 3、7 和 30 天内，转运患者出现复发性严重低血糖的几率分别为 2.8、5.2 和 10.6%，而非转运患者的发生率分别为 7.4、11.2 和 22.8%（所有 P < 0.001） . 这对应于转运患者与非转运患者 30 天内复发性严重低血糖的 OR 0.58 (95% CI 0.42–0.80)。当按糖尿病类型分类时，在 1 型和 2 型糖尿病中，转运患者中复发性严重低血糖的几率分别为 0.64 (95% CI 0.43–0.96) 和 0.42 (95% CI 0.24–0.75)。结论 转运患者经历需要就医的复发性低血糖症的发生率约为非转运患者的一半，这加强了让患者参与随访以防止再次发生事件的重要性。