384-P: Inadequate Follow-up and Intervention after Severe Hypoglycemia Treated by Emergency Medical Services (EMS)

Severe hypoglycemia incurs substantial morbidity and distress in patients with diabetes. Prior studies found that clinicians fail to screen for hypoglycemia and deintensify therapy after detected events. Whether patients treated by EMS for hypoglycemia receive follow-up or treatment modification to prevent hypoglycemia recurrence is unknown. We analyzed all 911 calls for hypoglycemia made by adults with diabetes to Mayo Clinic Ambulance Service (serving a large geographic area across Minnesota and Wisconsin) between 1/1/2013-12/31/2019, manually linked to Mayo Clinic electronic health records. Encounters within 7 days of the hypoglycemic event were analyzed for type of encounter, provider, discussion of hypoglycemia, prescription of glucagon, change of diabetes medications, and referral to a diabetes provider. Hypoglycemia was addressed more often with escalating levels of care (Figure). In-patient endocrinologists addressed hypoglycemia most often (96% discussion, 83% med changes), followed by hospitalists (87% discussion, 50% med changes). Primary care providers (74% discussion, 25% med changes) and emergency medicine providers (88% discussion, 14% med changes) addressed hypoglycemia less often. Results did not change when patients had experienced previous ED visits/hospitalization for hypoglycemia. Such therapeutic inertia hinders hypoglycemia prevention.