Factores asociados a reconsultas a urgencias en pacientes frágiles con diabetes tipo 2 que consultan por hipoglucemia / Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia

Introducción y objetivos: Las consultas a los servicios de urgencias (SU) por hipoglucemias son un fenómeno frecuente en los pacientes de edad avanzada. El objetivo del presente estudio es evaluar los factores de riesgo asociados a reconsultas a 90días en los pacientes frágiles que consultan al SU por episodios de hipoglucemia. Material y métodos: Estudio observacional retrospectivo. Se incluyeron pacientes >65años atendidos en un área de fragilidad del SU por hipoglucemias relacionadas con el uso de antidiabéticos orales y/o insulinas. Para evaluar los factores de riesgo asociados a reconsultas a los 90días se realizó un análisis multivariante mediante regresión logística, incluyendo las variables relacionadas con la comorbilidad y el tratamiento antidiabético con un valor de p<0,2 en el análisis univariante previo. Resultados: Se incluyeron 106 pacientes. El valor de %HbA1c estuvo disponible en 87 (82,1%) pacientes, de los cuales 10 (11,5%) presentaban una HbA1c ≤5,5%. Al alta, el tratamiento antidiabético se modificó a 63 (59,4%) pacientes. Reconsultaron a urgencias 38 (36,1%) pacientes, 9 (8,5%) de ellos por motivos relacionados con nuevas alteraciones de la glucemia. Los factores que se asocian a reconsultas a los 90días fueron: ser hombre (OR: 3,62 [IC95%: 1,24-10,51]), la modificación del tratamiento al alta (OR: 0,31 [0,11-0,91]) y presentar un valor de HbA1c ≤5,5% (OR: 5,33 [1,16-14,51]). Conclusiones: Los pacientes frágiles con diabetes que consultan al SU por hipoglucemia presentan con frecuencia cifras de HbA1c inferiores a las recomendadas, hecho que se asocia a un aumento en el riesgo de reconsulta a 90días (AU)

Introduction and objectives: Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia. Material and methods: A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis. Results: 106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]). Conclusions: Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days (AU)

[Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia]. / Factores asociados a reconsultas a urgencias en pacientes frágiles con diabetes tipo 2 que consultan por hipoglucemia.

INTRODUCTION AND OBJECTIVES: Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia. MATERIAL AND METHODS: A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis. RESULTS: 106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]). CONCLUSIONS: Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days.

Análisis de la evolución de consultas atendidas en los servicios deurgencias españoles durante la primera ola pandémica / Analysis of the evolution of patients attended in Spanish emergency departments during the first wave of the pandemic

Fundamento: Describir el número de consultas, total y porCOVID-19, atendidas en servicios de urgencias hospitalarios(SUH) españoles durante marzo y abril de 2020, compararlocon el mismo periodo del año anterior, cuantificar el cambiode actividad asistencial e investigar la posible influencia deltamaño del hospital y de la seroprevalencia provincial deCOVID-19. Métodos: Estudio transversal. Se envió una encuesta a todoslos responsables de SUH españoles del sistema público de salud sobre el número de consultas atendidas durante marzo yabril de 2019 y de 2020. Se calculó el cambio de actividad asistencial por comunidad autónoma, y se comparó en función deltamaño del hospital y del impacto provincial de la pandemia.Resultados: Participaron el 66 % de los 283 SUH. Se observó undescenso del 49,2 % de las consultas totales (solo los SUH deCastilla-La Mancha mostraron un descenso inferior al 30 %) ydel 60 % de las consultas no-COVID-19 (solo los SUH de Asturias y Extremadura mostraron un descenso inferior al 50 %). elcambio de actividad asistencial no difirió en función del tamaño del hospital, pero sí en relación al impacto provincial de lapandemia, con una correlación directa respecto al descensode actividad no-COVID-19 (a mayor impacto, mayor descenso;R2 = 0,05; p = 0,002) e inversa en relación a la actividad global (amayor impacto, menor descenso; R2 = 0,05; p = 0,002).Conclusiones: Durante la primera ola pandémica descendió elnúmero de consultas en los SUH, si bien dicho descenso nose explica únicamente por la incidencia local de la pandemia.(AU)

Background: To describe the number of visits (total and perCOVID-19) attended by the Spanish hospital emergency departments (EDs) during March and April 2020 compared to thesame period in 2019, and to calculate the quantitative changesin healthcare activity and investigate the possible influence ofhospital size and regional COVID-19 seroprevalence. Method: Cross-sectional study that analyzes the number ofvisits to Spanish public EDs, reported through a survey ofED chiefs during the study periods. Changes in healthcareactivity were described in each autonomous community andcompared according to hospital size and the regional impactof the pandemic. Results: The 66% of the 283 Spanish EDs participated in thestudy. The total number of patients attended decreased to49.2 % (< 30 % in the Castilla-La Mancha region), with a 60 %reduction in non-COVID-19 patients (reduction < 50 % only inthe regions of Asturias and Extremadura). While there wereno differences in changes of healthcare activity according tothe size of the hospital, there were differences in relation tothe regional impact of the pandemic, with a direct correlationrelated to the decrease in non-COVID-19 activity (the greaterthe impact, the greater the decrease; R2 = 0.05; p = 0.002) andan inverse correlation to the overall activity (the greater theimpact, the lesser the decrease; R2 = 0.05; p = 0.002). Conclusion: There was a very significant decrease in the numberof ED visits during the first pandemic wave, although this decreasecannot be explained solely by the local incidence of the pandemic.(AU)

[Analysis of the evolution of patients attended in Spanish emergency departments during the first wave of the pandemic].

BACKGROUND: To describe the number of visits (total and per COVID-19) attended by the Spanish hospital emergency departments (EDs) during the first wave of the pandemic (March-April 2020) compared to the same period in 2019, and to calculate the quantitative changes in healthcare activity and investigate the possible influence of hospital size and COVID-19 seroprevalence. METHOD: Cross-sectional study that analyzes the number of visits to Spanish public EDs, reported through a survey of ED chiefs during the study periods. Changes in healthcare activity were described in each autonomous community and com-pared according to hospital size and the provincial impact of the pandemic. RESULTS: A total of 187 (66?%) of the 283 Spanish EDs participated in the study. The total number of patients attended de-creased to 49.2?% (

Diabetes en urgencias: evaluación del control y tratamientos instaurados / Diabetes in emergency services: evaluation of monitoring and installed treatments

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Variabilidad glucémica, un nuevo concepto de difícil control / Glycaemic variability, a new concept of difficult control

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