Influencia del tratamiento para la diabetes en la aparición de urgencias diabetológicas

Abstract

Objective. Evaluate the influence of hypoglycemia treatment in the appearance and treatment of acute complications of diabetes. Material and methods. Descriptive, retrospective study conducted in a hospital emergency service (HES). Patients seen between July and December 2014 with a diagnosis of hypoglycemia or hyperglycemic decompensation (HGD) were included. Children under 14 years of age and patients diagnosed of gestational diabetes were excluded. Variables collected were: age, age group (AG), gender, type of DM, treatment for the DM, type of oral antidiabetic (OAD), number of OAD, type of insulin, diagnosis and destination of the patient. Results. A total of 117 patients, mean age 65.8 (SD 18.3) years were enrolled. Of these, 85.8% had type 2 diabetes (DM2). Treatment followed was: insulin 49.6%, oral antidiabetics (OAD) 27.4%, insulin plus OAD 19.6%, diet 3.4 %. Patients under treatment with an OAD used one drug in 60.7 % of the cases, two drugs in 33.9% and three drugs in 5.4%. Metformin was present as treatment in single drug therapy in 64.7% of the cases. Diagnoses on discharge were hyperglycemic decompensation (HGD) 63.2% and hypoglycemia 36.8%. HGD predominated in all the treatments, except in those treated with sulfonylureas in single drug treatment: 83.3% hypoglucemias. Those treated with DPP4 inhibitors presented hyperglycemic decompensation in 84.2% of the cases and hypoglycemia in 15.8% (p<0.01). A total of 46.2% of the cases were hospitalized, 59.3% of them due to hyperglycemias. Hospitalization occurred in 50% of those treated with insulin and 42.9% of those only treated with OAD compared to 38.1% of those treated with insulin plus OAD. Conclusions. Diabetic emergencies are frequently seen in the hospital emergency service. DM2, above all due to HGD, consult more frequently. Choice of hypoglycemic treatment should be individualized, since it influences in the appearance of the acute decompensations.