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March 26, 2014
Insulin-Related Errors Send Thousands to EDs,
Especially the Elderly Atlanta—Nearly 100,000 patients with diabetes seek emergency care for insulin-related errors (IHE) each year, and nearly a third of those are admitted to the hospital, according to a new study from the CDC. Severe neurological conditions, including shock, loss of consciousness, seizure or a hypoglycemia-related fall or injury, were documented in 60.6% of the cases, according to the study published recently in JAMA Internal Medicine. The problem is especially severe for patients 80 years or older treated with insulin; they were more than twice as likely to visit the ED and nearly five times more likely to be hospitalized because of IHEs than patients 45 to 64 years old, according to the report. “Insulin remains one of the most challenging aspects of managing diabetes because of complexities in dosing and administration of the medication, as well as the need to monitor blood glucose. The risk of insulin-related hypoglycemia is an important consideration when choosing among treatment options,” the authors point out. To derive annual numbers and rates of ED visits and hospitalizations for IHEs among patients with diabetes treated with insulin, CDC researchers analyzed data on adverse drug events among insulin-treated patients seeking ED care and from a national household survey of insulin use from 2007 through 2011. Based on 8,100 adverse drug event cases, the authors estimated that 97,648 ED visits for IHEs occurred annually and that nearly one-third (29.3%) resulted in hospitalization. In the 20.8% of patients in whom factors leading up to the ED visit were documented, meal-related issues such as not eating after taking a fast-acting medication or not adjusting the insulin regimen to make up for reduced calories were involved in 45.9% of cases. About 22.1% of the emergency visits stemmed from taking the wrong insulin product, and 12.2% involved taking the wrong dose. “Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae (conditions) in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts,” the authors note. An accompanying commentary by Sei J. Lee, MD, MAS, of the Division of Geriatrics, University of California, San Francisco and Division of Geriatrics, San Francisco VA Medical Center, San Francisco, California, calls the results “striking.” “First, across all age groups, patients taking only insulin were several times more likely to have an ED visit for hypoglycemia than were patients taking insulin with oral glucose-lowering medications. Second, older adults (aged > 80 years) have nearly twice the risk of hypoglycemia as younger adults. Finally, insulin-related hypoglycemia is remarkably common,” Lee writes, adding, “Beyond the findings that patients 80 years or older and those taking only insulin are at higher hypoglycemia risk, it is important to recognize the absolute magnitude of the hypoglycemia epidemic. There are nearly 100,000 ED visits for insulin-related hypoglycemia annually, compared with 715,000 myocardial infarctions. Unlike myocardial infarctions, the vast majority of hypoglycemia episodes are caused by the health care system.”
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U.S. Pharmacist Social Connect
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