Out-of-hospital hypoglycaemia is safely and cost-effectively treated by paramedics

The purpose of this study was to investigate the clinical epidemiology of severe out-of-hospital hypoglycaemia, to evaluate the standard treatment protocol used, to investigate the clinical outcome during a 3-month follow-up period and to evaluate financial savings achieved by not transporting all patients to hospital.

This study was a prospective, observational study based on questionnaires and patient files. Two paramedic units of the Rescue Department filled in a study form on each hypoglycaemia patient they enrolled between 1 February 2001 and 31 December 2001. These patients were contacted by mail after 3 months and asked to fill in a questionnaire regarding their health.

Sixty-nine patients were included in the study. The majority of the patients had diabetes mellitus for more than 5 years. The severity of hypoglycaemia was related to the duration of diabetes (P = 0.003) and insulin therapy (P = 0.021). Fifty-eight patients (84.1%) required intravenous glucose treatment. Sixty-two patients (89.9%) were left at the scene after treatment. No immediate relapses occurred. Mean patient satisfaction was 4.6 (SD 0.8) on a scale from 1 to 5. Satisfaction was related to the duration of diabetes (P<0.0001) and to low haemoglobin A1c values (P<0.0001). The direct savings achieved by not transporting the patient to the hospital emergency department were estimated to be 398.5 per patient.

The emergency medical services guideline for the treatment of hypoglycaemia and the practice of leaving selected patients at the scene after treatment were found to be effective, safe and economical. Patient satisfaction was found to be high, further supporting the practice of not transporting all patients to hospital.