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Cited by 11Diabetes Management and ResearchEmergency and Acute Care StudiesNeurological and metabolic disorders

Hypoglycaemia without Diabetes Encountered by Emergency Medical Services: A Retrospective Cohort Study

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Vihonen, Hanna, Kuisma, Markku, Nurmi, Jouni·2018·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
DOI 10.1186/s13049-018-0480-7PMC PMC5796568
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Abstract

BACKGROUND: The current study investigates the incidence, aetiology, and outcome of hypoglycaemia of patients without diabetes in the EMS. METHODS: The study was a retrospective cohort study that utilized electronic EMS patient record system (population of one million). All patients encountered by EMS with plasma glucose ≤3.9 mmol/l from 2009 to 2015 were included in the study and hospital records were screened manually to detect possible reasons for hypoglycaemia. Data from the governmental health insurance agency for all residents in Finland was used to reveal the diabetes status of the patients. Survival of the patients was followed from Population register centre up to six years. Serious hypoglycaemia was defined as plasma glucose ≤3.0 mmol/l. RESULTS: From EMS cases with a plasma glucose measurement a total of 5467 hypoglycaemic patients without diabetes were encountered by EMS during the study period with an incidence of 1082 (CI95% 1019-1148) per 100,000 inhabitants per year, corresponding 41.6%, (CI95% 40.8-42.3) of all hypoglycaemic patients. Of those patients, 3856 [71.6%, (CI95% 70.4-72.8)] were transported to hospital and 910 [23.2%, (CI95% 22.0-24.6)] had serious hypoglycaemia. The three main diagnosis groups that appeared in the subsequent hospital treatment associated with hypoglycaemia in all transported cases without diabetes as well with serious hypoglycaemia cases were: alcohol abuse [41.2%, (CI95% 39.7-42.8) and 42.2%, (CI95% 39.0-45.4)], hypothermia [17.2%, (CI95% 16.0-18.4) and 27.4%, (CI95% 24.6-30.4)], and malnutrition [16.9%, (CI95% 15.8-18.1) and 25.1%, (CI95% 22.4-28.0)]. Mortality ranged from 0.6-65.4% depending of admission reason and increased significantly at long-term. Non-Diabetics survival was less than with diabetics, when serious hypoglycaemia was present. DISCUSSION: The most common possible hypoglycaemia related aetiological causes encountered in the EMS, alcohol abuse, hypothermia, and malnutrition, although frequent are often relatively benign conditions. These possible causes of hypoglycaemia can often be treated at scene or need only short hospital admissions. Hence they are not so prevalent in hospital studies. CONCLUSIONS: Hypoglycaemia without diabetes is commonly observed among the hypoglycaemic EMS cases. Main causes for it are alcohol abuse, hypothermia, and malnutrition. Mortality correlated with age, higher priority dispatch codes, and plasma glucose rate in multivariate logistic regression analysis. Some of the etiological subgroups carry a markedly high mortality rate.

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  • In adult patients without diabetes, hypoglycemia is rare and much less common than in patients with diabetes.

    “Hypoglycemia in adult patients without diabetes is rare and much less common compared to patients with diabetes.”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [2]

    The Background says hypoglycaemia is frequently observed in patients without diabetes, contrary to the claim that it is rare. The Abstract Results report that patients without diabetes accounted for 41.6% of hypoglycaemic EMS patients—fewer than patients with diabetes, but not much fewer. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • In a six-year retrospective study in Finland, the rate of hypoglycemia-related emergency medical service encounters for non-diabetic hypoglycemia was 1.1% (1082/100,000 persons per year).

    “For instance, in a six-year retrospective study in Finland, the rate of hypoglycemia-related emergency medical service encounters for non-diabetic hypoglycemia was only 1.1% (1082/100,000 persons per year) [2].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [2]

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Authors
Vihonen, H., Kuisma, M., & Nurmi, J.
Affiliations
University of Helsinki (FI)
Corresponding author
Vihonen, Hanna
ORCID
Venue
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Publisher
Springer Science and Business Media LLC
Published
2018-02-01
Volume
26
Issue
1
Pages
12-12
ISSN
1757-7241 (ISSN-L)
DOI
10.1186/s13049-018-0480-7
PMC
PMC5796568
OpenAlex
W2792401907
Cited by
11
References
29
Citations by year
2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2019: 1
FWCI
0.80
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Työväentutkimus Vuosikirja (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
Keywords
hypoglycemia, emergency medical services, hypoglycaemia incidence, alcohol abuse, hypothermia, malnutrition, mortality, long-term survival, hospitalization, plasma glucose, Finland, hospital discharge data, emergency department visits
MeSH terms
Adult, Aged, Blood Glucose, Diabetes Mellitus, Emergency Medical Services, Female, Finland, Hospitalization, Humans, Hypoglycemia, Male, Middle Aged, Retrospective Studies, Incidence, Prevalence

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