![]() ![]() There have been limited studies describing prehospital hypoglycemia requiring paramedic assistance. Thus, although reported rates of emergency department visits for hypoglycemia are high - a US study estimated more than 97 000 emergency department visits per year for insulin-related hypoglycemia 18 - the true burden of severe hypoglycemia is likely higher when considering events not leading to an emergency department visit. After an ambulance call, patients may decline hospital transport and hence may not have emergency department assessment. Emergency medical assistants have the narrowest scope of practice, followed by primary care paramedics, primary care paramedics with advanced training to administer intravenous medications, and then advanced care paramedics, who administer a wide variety of medications, including via intravenous administration. Ontario ambulance crews include emergency medical assistants or paramedics. In Canada, paramedic scope of practice varies by province. 17 Despite serious consequences, it is probable that only some patients with severe hypoglycemia present to hospital, while others are treated only at the scene, by family or friends, or by emergency medical services thus many episodes are “invisible” to the health care system. 3 Insulin and oral antihyperglycemic agents were the second and fourth medications, respectively, most frequently associated with emergency hospitalization among adults aged 65 years and older in the United States. 16 In Canada, 23% of people who presented to emergency departments with severe hypoglycemia were hospitalized (2008–2010). 8, 9 The economic costs are substantial in terms of the associated use of health care. ![]() Severe hypoglycemia is associated with increased cardiovascular events, 1, 2 injury 3 and mortality 1, 2, 4, 5 it impairs quality of life 6, 7 and discourages targeting tight glycemic control. The incidence of severe hypoglycemia ranges from 0.8 to 3.2 events per person-year, 10, 12 – 15 and annual prevalence ranges from 10% to 53% for type 1 diabetes 12 and from 4.4% to 6% for type 2 diabetes. 1 – 10 Severe hypoglycemia, that is, hypoglycemia requiring third-party assistance, 11 is a major health concern. It negatively affects many health-related outcomes. Hypoglycemia is common in diabetes mellitus. ![]() Physicians managing diabetes care may be unaware of patients’ hypoglycemia requiring paramedic care, suggesting a potential gap in follow-up care we suggest that paramedics play an important role in identifying those at high recurrence risk and communicating with their care providers. Interpretation: Hypoglycemia requiring paramedic assistance in southwestern Ontario is common, and close to 25% of calls do not result in hospital transport. ![]()
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