Hypoglycaemia: missing meals were a major identified cause of hypoglycaemic coma in type 1 diabetes

Clinical bottom line (level 4)

  1. Missed meals were the major attributed cause for hypoglycaemia in type 1 diabetes (25% of cases)
Collier et al: Diabetes Care 1987; 10 (6): 712-715
Expires August 2003

The study

Setting: accident and emergency department in Edinburgh, UK

49 patients (aged mean 40 years, ?% male) hypoglycaemic coma associated with known insulin-dependent diabetes mellitus (IDDM)

Excluded if
  • Subsequent visits of previously entered patients
  • Co-morbidity with Addison's disease



    • Non-independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    No obvious cause 15 30%
    (18% to 44%)
    Missed meal 12 25%
    (12% to 37%)
    Irresponsible attitude 10 20%
    (9% to 32%)
    Exercise 7 14%
    (4% to 24%)
    Excessive alcohol intake 3 6%
    (1.3% to 17%)
    Miscellaneous other 2 4%
    (0.5% to 14%)

    Comments

    1. Diagnoses determined by retrospective questioning of patients, friends and relatives. No further explanations given.

    Citation

    1. Collier A, Steedman DJ, Patrick AW, et al: Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycaemia in an accident and emergency department. Diabetes Care 1987; 10 (6): 712-715
    Contributor: Bob Phillips and Clare Wotton, August 1999
    Reviewer:

    Clinical Question.
    Patient hypoglycaemic
    Intervention or Exposure prevalence
    Outcome causes