OAKLAND, CA—Data from more than 1.3 million VHA patients was used to help validate a practical tool for identifying people with diabetes who are at the highest risk for being admitted to an emergency department or hospital due to severe hypoglycemia.
Also used to confirm the effectiveness of the tool was information from nearly 15,000 Kaiser Permanente members in Washington state with Type 2 diabetes, according to the report JAMA Internal Medicine.1
“Sometimes a person with diabetes is unaware that their blood sugar is dropping and can progress quickly into severe hypoglycemia, which has been associated with falls, automobile accidents, heart attacks, coma and even death,” explained lead author Andrew J. Karter, PhD, senior research scientist with the Kaiser Permanente Division of Research. “Hypoglycemia is often preventable with the proper clinical attention, and we believe this tool will help focus that attention on the patients who most need it.”
Hypoglycemia accounts for an estimated 100,000 adverse events resulting in emergency department (ED) visits each year in the United States, making it one of the most frequent adverse events in patients with Type 2 diabetes. Especially susceptible, according to Karter, are older patients and those with a longer history of diabetes.
The hypoglycemia risk stratification tool was developed by identifying 156 possible risk factors for hypoglycemia and collecting data from more than 200,000 patients with type 2 diabetes receiving care from Kaiser Permanente in Northern California. The information was analyzed, and a model was created to predict a patient’s 12-month risk of hypoglycemia-related ED or hospital use.
Six variables made up the final model:
- number of prior episodes of hypoglycemia-related emergency department visits or hospitalizations;
- use of insulin;
- use of sulfonylurea;
- severe or end-stage kidney disease;
- number of emergency room visits for any reason in the past year; and age
Development of the tool was funded by the Food and Drug Administration (FDA) under the Safe Use Initiative, a collaborative effort to reduce adverse events related to medication use, including diabetes medications linked to an increased risk of hypoglycemia. The results are being disseminated with help from the Centers for Medicare and Medicaid Services (CMS).
- Karter AJ, Warton EM, Lipska KJ, Ralston JD, Moffet HH, Jackson GG, Huang ES, Miller DR. Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use. JAMA Intern Med. 2017 Oct 1;177(10):1461-1470. doi: 10.1001/jamainternmed.2017.3844. PubMed PMID: 28828479; PubMed Central PMCID
Most people looking at a hospital room will see an environment specifically designed to keep human beings alive through even the most traumatic circumstances.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.