Studies Of The Clinical Features And Factors Related To The Outcome Of Prehospital Hypoglycemia In Zigong City

Objective: Hypoglycemia is a well-recognized side effect ofglucose lowering therapies in patients with diabetes mellitus，and a commondisease of prehospital care. It is essential to instruct doctors to assess thedisease and predict the outcome in the field, make the education about diabetesand hypoglycemia for the people, improve the ability of diagnosis andtreatment for hypoglycemia in the prehospital care, and promote the outcome ofprehospital hypoglycemia by analyzing the clinical features and factors relatedto the outcome of prehospital hypoglycemia。 Methods: Establishing theprehospital database and completing the clinical data of prehospitalhypoglycemia, we analyzed retrospectively all the data of prehospitalhypoglycemia between January1,2006and December31,2011in Zigong.1.We described statistically the general data of the patients with hypoglycemia,and the content included:⑴The number of prehospital hypoglycemia eachyear were described, and these categorical variables were summarized usingproportions and compared between groups using the χ2test⑵The number ofpatients with or without diabetes were described, and these variables weresummarized using proportions⑶The causes of hypoglycemia with or withoutdiabetes were described, and these variables were summarized usingproportions⑷The method of circular distribution was used to analyze thecharacteristics of temporal distribution of prehospital hypoglycemia⑸The clinical manifestations and the treatments were described⑹The prognosis ofthe patients were described, and these variables were summarized usingproportions.2. The chi-square test, Fisher probabilities, Independent-Sample TTest and mann-whitney u test were used to compare between the groups withand without diabetes, the groups with oral medication and Insulin, and thegroups with Glibenclamide and the other oral medication.3. The correlationbetween the outcome of hypoglycemia or hypoglycemia related to diabetes andthe factors chosen by chi-square test, Fisher probabilities, Independent-SampleT Test and mann-whitney u test was assessed by Logistic regression analysis.Results:1.We studied242patients with prehospital hypoglycemia betweenJanuary1,2006and December31,2011in Zigong (0.91%of the patients in theprehospital care), and the proportions of each year were not significant different(P＞0.05).The number of patients with diabetes was192(79.3%), and thenumber of patients without diabetes was50(20.7%). There was no peak time inthe weekly and monthly distribution (P＞0.05).In the circadian distribution, theoccurrence of prehospital hypoglycemia peaked at13:25and with the highfrequency between8:33and18:18(P＜0.05). Of these patients,116patients(47.9%) were in a coma,78patients (32.2%) were in a state of confusion,18patients (7.4%) were in a stupor,4patients (1.7%) were somnolent，26patients(10.7%) were conscious.224patients (92.6%) were recovered, and18patients(7.4%) were not recovered.2. The differences of these factors (gender, age,degree of education, district, heart rate, respiratory rate, systolic pressure,Glasgow Coma Scale, SPO2, the ratio of recovery, blood glucose concentration, duration of hypoglycemia and symptom) between the groups with and withoutdiabetes were not significant (P＞0.05). The differences of these factors (gender,age, district, heart rate, respiratory rate, systolic pressure, SPO2, the ratio ofrecovery, blood glucose concentration, duration of hypoglycemia and symptom)between the groups with oral medication and Insulin were not significant (P＞0.05), but degree of education and Glasgow Coma Scale between the groupswere significant (P＜0.05). The differences of these factors (gender, age, degreeof education, district, heart rate, respiratory rate, systolic pressure, GlasgowComa Scale,SPO2, the ratio of recovery, blood glucose concentration, durationof hypoglycemia and symptom) between the groups with Glibenclamide andthe other oral medication were not significant (P＞0.05).3.A significantpositive correlation between the outcome of the hypoglycemia and the factors(age, Glasgow Coma Scale, blood glucose concentration, duration ofhypoglycemia and symptom) was obtained (P＜0.05), and a significant positivecorrelation between the outcome of the hypoglycemia with diabetes and thefactors (age, the blood glucose concentration, the duration of hypoglycemia andthe symptom) was obtained (P＜0.05). Conclusion:1.The number ofprehospital hypoglycemia was continuously high, and we should allocate thework properly on the basis of prehospital temporal distribution, but we ought topay more attention to nocturnal hypoglycemia.2. We should attach importanceto the factors related to unfavourable prognosis of hypoglycemia (the older age,the lower Glasgow Coma Scale, the lower blood glucose concentration, thelonger duration of hypoglycemia, and the hypoglycemia unawareness), and diagnose and treat hypoglycemia as soon as possible for the improvement ofprognosis.