Hypoglycaemia: Intramuscular and intravenous glucagon were similar in effect

Clinical bottom line (level 2b-)

In patients with hypoglycaemic coma, intramuscular and intravenous glucagon appeared similar in their ability to rouse.

MacCuish et al: Lancet 1970; 1: 946-949

Expires August 2003

The study

Single-blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: diabetic or accident and emergency department of one hospital, UK

100 patients (aged range 20 to 40 years, ?% male) diabetics brought by ambulance or car at the request of a doctor, relative, friend or police, with suspected hypoglycaemia
Control Group: (n = 50, 50 analysed): intravenous glucagon 1mg
Experimental Group: (n = 50, 50 analysed): intramuscular glucagon

100% followed for 60 minutes

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
recovery in <0 mins	30 minutes	32 (64%)	27 (54%)	16% (-17% to 39%)	10% (-9% to 29%)	10 (NNT = 3 to infinity; NNH = 11 to infinity)

Comments

No details of randomisation given; from exact 50/50 split and the decision to enter 100 patients it may be reasonable to assume it's alternate allocation
'Recovery' included ability to take oral glucose; may vary from other definitions

Citation

MacCuish AC, Munro JF, Duncan LJP: Treatment of hypoglycaemic coma with glucagon, intravenous dextrose, and mannitol infusion in a hundred diabetics. Lancet 1970; 1: 946-949

Contributor: Bob Phillips and Clare Wotton, August 1999
Reviewer:

_{Clinical Question.}

_Patient	_{in patients with hypoglycaemia and altered mental status}
_{Intervention or Exposure}	_{intravenous glucagon}
_Comparison	_{intramuscular glucagon}
_Outcome	_{speed of recovery or requirement for further treatment}