Hypoglycemic treatment of diabetic patients in the Emergency Department

Farm Hosp. 2016 May 1;40(3):172-86. doi: 10.7399/fh.2016.40.3.10060.


Objectives: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact.

Methods: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed.

Results: 78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%). The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 } 49.5 mg/dL versus 182.7 } 97.1 mg/dL (p = 0.688); mean rescues with insulin lispro: } 1.6 versus 1.5 } 1.8 (p = 0.293); mean units of insulin lispro administered: 4.6 } 12.7 IU versus 6.6 } 11.3 IU (p = 0.155).

Conclusions: We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment.

Objetivo: Analizar la adecuacion del tratamiento hipoglucemiante prescrito en el Servicio de Urgencias a las recomendaciones de consenso disponibles, asi como evaluar su repercusion clinica. Método: Estudio observacional descriptivo. Se incluyeron pacientes que se encontraban en la sala de observacion del Servicio de Urgencias pendientes de ingreso hospitalario, con diagnostico previo de diabetes mellitus y en tratamiento domiciliario con farmacos hipoglucemiantes. Se evaluo el manejo del tratamiento antidiabetico y su repercusion clinica. Resultados: Se incluyeron 78 pacientes. Al ingreso en el Servicio de Urgencias se modifico el tratamiento en el 91% de los pacientes, y se omitio en el 9%, siendo el tratamiento mas pautado los rescates con insulina rapida (68%). Los tratamientos prescritos se ajustaron en un 16,7% a las recomendaciones de la Sociedad Espanola de Medicina de Urgencias y Emergencias. Tras la intervencion del farmaceutico, la omision descendio al 1,3% y la adecuacion a las recomendaciones aumento al 20,5%. Comparando los pacientes cuyo tratamiento se ajusto a las recomendaciones y los que no, la repercusion clinica fue, respectivamente: media de glucemia a las 24 horas 138,3 } 49,5 mg/dL versus 182,7 } 97,1 mg/dL (p = 0,688); media de rescates con insulina lispro 1 } 1,6 versus 1,5 } 1,8 (p = 0,293); media de unidades de insulina lispro administradas 4,6 } 12,7 UI frente a 6,6 } 11,3 UI (p = 0,155). Conclusiones: Encontramos una baja adecuacion de las prescripciones de antidiabeticos a las recomendaciones de consenso. Estos resultados van en linea con otros estudios, objetivandose un abuso de las pautas de rescate con insulina rapida como unico tratamiento hipoglucemiante.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus / drug therapy*
  • Drug Prescriptions / statistics & numerical data
  • Emergency Medical Services*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / therapeutic use
  • Male
  • Medication Therapy Management*
  • Middle Aged


  • Hypoglycemic Agents
  • Insulin