Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia
dc.contributor.author | Hope, SV | |
dc.contributor.author | Taylor, PJ | |
dc.contributor.author | Shields, BM | |
dc.contributor.author | Hattersley, AT | |
dc.contributor.author | Hamilton, W | |
dc.date.accessioned | 2017-09-14T12:26:55Z | |
dc.date.issued | 2017-09-11 | |
dc.description.abstract | Introduction We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia. Methods 335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, “hypo clues”. Results 27/79(34%) insulin-treated patients had >1 documented hypoglycaemia episode, compared to 4/85(5%) sulphonylurea-treated patients, 2/121(2%) metformin-only treated patients, and none without diabetes, p < 0.001. “Hypo clue” consultations were common: 1.37 consultations/patient/year in insulin-treated patients, 0.98/patient/year in sulphonylurea-treated, 0.97/patient/year in metformin only-treated, and 0.78/patient/year in non-diabetic patients, p = 0.34. In insulin-treated patients with documented hypoglycaemia, 20/27(74%) attended on another occasion with a “hypo clue” symptom, compared to 21/52(40%) of those without hypoglycaemia, p = 0.008. No significant difference in the other treatment groups. Nausea, falls and unsteadiness were the most discriminatory symptoms: 7/33(21%) with hypoglycaemia attended on another occasion with nausea compared to 14/302(5%) without hypoglycaemia, p = 0.002; 10/33(30%) vs 36/302(12%) with falls, p = 0.007; and 5/33(15%) vs 13/302(4%) with unsteadiness, p = 0.023. Conclusions Non-specific symptoms are common in those >65 years. In insulin-treated patients at high hypoglycaemia risk, nausea, falls and unsteadiness should prompt consideration of hypoglycaemia. | en_GB |
dc.identifier.citation | Available online 11 September 2017 | en_GB |
dc.identifier.doi | 10.1016/j.pcd.2017.08.004 | |
dc.identifier.uri | http://hdl.handle.net/10871/29338 | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.rights | Creative Commons Attribution Licence CC-BY | en_GB |
dc.subject | Elderly | en_GB |
dc.subject | Hypoglycaemia | en_GB |
dc.subject | Diagnosis | en_GB |
dc.subject | Symptoms | en_GB |
dc.subject | Insulin | en_GB |
dc.subject | Falls | en_GB |
dc.title | Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2017-09-14T12:26:55Z | |
dc.identifier.issn | 1751-9918 | |
dc.description | This is the final version | en_GB |
dc.description | Available from Elsevier via the DOI in this record | en_GB |
dc.identifier.eissn | 1878-0210 | |
dc.identifier.journal | Primary Care Diabetes | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ |
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