Hypoglycaemia: Most hypoglycaemic patients had diabetes

Clinical bottom line (level 4)

  1. 80% of hypoglycaemic admissions suffered diabetes
  2. 90% of non-diabetics had alcohol induced hypoglycaemia
Hart and Frier: Q J Med 1998; 91: 505-510
Expires August 2003

The study

Setting: Teaching hospital records in Edinburgh, UK

51 patients (aged range 17 to 87 years; median 44, 55% male) Hypoglycaemia requiring hospital admission

Excluded if
  • age <16y


    • Hypoglycaemia required an adequate description of clinical manifestation, without necessarily biochemical confirmation and an improvement in response to treatment.
    Non-independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.

    The evidence

    pre-test probability of Hypoglycaemia requiring hospital admission: 0.4%, (95% CI: 0.3% to 0.5%)

    differential diagnosis number of patients prevalence
    (95% CI)
    cause- inadequate carbohydrate intake 16 28%
    (15% to 40%)
    unidentified causes 15 27%
    (12% to 35%)
    cause- alcohol 11 20%
    (20% to 46%)
    insulin overdosage (deliberate or accidental) 10 20%
    (9% to 31%)
    strenuous exercise 4 7%
    (0% to 12%)
    admission with IDDM 30 59%
    (45% to 72%)
    admission with NIDDM 8 16%
    (6% to 26%)
    insulin-treated diabetes secondary to chronic pancreatitis 3 6%
    (0% to 12%)
    alcohol induced hypoglycaemia without underlying diabetes 9 18%
    (7% to 28%)
    parasuicide without diabetes 1 2%
    (0% to 10%)

    • 56 episodes in 51 patients
    • Discharge coding misidentified 16 cases and failed to identify a further 9 cases

    Comments

    1. Retrospective study based on case-note selection from two sources; medical admission logs and discharge coding documents. May easily miss cases.
    2. Diagnoses and aetiologies determined by unblinded, unverified case-note review without formal definitions.

    Citation

    1. Hart SP, and Frier BM: Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission. Q J Med 1998; 91: 505-510
    Contributor: Bob Phillips and Clare Wotton, August 1999
    Reviewer:

    Clinical Question.
    Patient hypoglycaemia
    Intervention or Exposure prevalence
    Outcome cause, underlying disease