An evaluation of recurrent hypoglycemia across Chicago, Illinois.
AIMS
Recurrent hypoglycemia is understudied. This study evaluates recurrent hypoglycemia, fragmentation of care and mortality in a large urban center.


METHODS
The Chicago HealthLNK Data Repository (CHDR), a de-identified electronic health record data set from institutions across Chicago, identified 9741 patients with diabetes (DM) who had hypoglycemia (emergency department (ED) or inpatient admission (IA)) from 2006 to 2012. Recurrence was defined as more than one hypoglycemia encounter, and fragmentation of health care was defined as an ED visit or IA for hypoglycemia at >1 site.


RESULTS
187,644 patients were identified with DM; of 9741 patients with hypoglycemia, 2857 (29.3%) had recurrence. Patients with ≥4 hypoglycemic encounters (n = 1035) represented 10.6%, but accounted for 40.3% hypoglycemic encounters. Of 2857 patients with recurrence, 304 patients (10.6%) had fragmented care. In those with high hypoglycemic encounters (≥4), 22% (N = 226) had ≥10 encounters; race and insurance status differences were associated with number of hypoglycemic encounters. Having hypoglycemia was associated with increased mortality compared to no hypoglycemia (n = 2696, 27.7% vs n = 20,188, 11.4%; p < 0.00001 by chi-square).


CONCLUSION
A small subset of patients with hypoglycemia accounted for a large subset of hypoglycemia encounters. Targeted interventions in this high-risk, high mortality group are needed.
["O'Connor|Clare E|CE|", 'Oh|Elissa H|EH|', 'Jackson|Kathryn L|KL|', 'Finn|Daniel J|DJ|', 'Rosenman|Marc B|MB|', 'Molitch|Mark E|ME|', 'Kho|Abel|A|', 'Wallia|Amisha|A|']
D002641:Chicago D006760:Hospitalization D006801:Humans D007003:Hypoglycemia D007087:Illinois
Hypoglycemia Fragmentation of care Diabetes mellitus