Diabetes is associated with a number of acute, life threatening complications. Yet, data on the utilisation of ambulance services for management of diabetic emergencies is limited. We examine the incidence of diabetic emergencies and factors that are associated with ambulance care.
This large observational study examined state-wide collected data from Ambulance Victoria (AV) from 1/1/2009 to 31/12/2011. Subjects fulfilling the criteria of paramedic assessment of hypoglycaemia or hyperglycaemia were identified from the AV database. Data on pre-specified demographic, clinical and outcome variables, was extracted. Differences between subgroups were tested using univariable regression or the χ2 test, as appropriate.
A total of 17,816 episodes of care were identified as diabetic emergencies [hypoglycaemia 13,260 (74.4%) and hyperglycaemia 4,556 (25.6%)] during the 3-year period. The mean age (± SD) of the patients was 56.9 (± 22.3) years with male patients accounting for 54.8 % of all episodes. The majority of the episodes were provided at private homes (71.4%) followed by public spaces (14.9%) and supported residential facilities (8.5%). Regardless of the type of diabetes, hypoglycaemia was the more common cause of diabetes emergency requiring ambulance attendance (74.4%). 73.2% of the episodes were provided to metropolitan locations compared to 26.8% to regional/rural locations with no geographic differences in the type of emergencies attended. Patients reporting type 1 diabetes more often required management of hypoglycaemia whereas patients reporting type 2 diabetes more often required management of hyperglycaemia. Transport to hospital was required by 40.3% of patients with hypoglycaemia compared to 84.7% of patients with hyperglycaemia.
Examination of ambulance service use has identified a previously unquantified need for emergency health services by patients with diabetes. This suggests that widespread, targeted education programs addressing prevention, recognition and early self-management of acute diabetic emergencies with particular focus on hypoglycaemia is urgently required.