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Hypoglycemia

Date Last Search Run: Feb 01, 2022
Table last updated: Sep 29, 2022
Data last added: Sep 10, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)  
3 (weak evidence exists)      


Interventions

D10
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Symptom improvement Patient PH-Paramedic Hurtubise M, Stirling J, Greene J, Carter AJ, Swain J, Brown R, et al. Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review. Prehosp Disaster Med 2021; 36(6):730–8. Medline
I Supportive (Green) Time to GCS recovery Process Moore C., Wollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg Med J 2005; 22:512-515 Medline
II Supportive (Green) Resoration of BGL without re-administation Patient PH-Paramedic Weant KA, Deloney L, Elsey G, Combs D, French D. A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting. J Pharm Pr 2021; 34(4):606–11. Medline
III Supportive (Green) Feasibility Process Hern HG., Kiefer M., Louie D., Barger J., Alter HJ. D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors ;21(1):63-67. Medline
III Supportive (Green) Feasibility Process Kiefer MV., Gene HH, Alter HJ., Barger JB. Dextrose 10% in the treatment of out-of-hospital hypoglycemia. Prehosp Disaster Med 2014;29(2):190-4. Medline

D50W
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time until full recovery Patient ED-MD Carstens S., Sprehn M. Prehospital treatment of severe hypoglycemia: A comparison of intramuscular glucagon and intravenous glucose. Prehos Dis Med 1998; 13(2):114-25. Medline
I Supportive (Green) Satey Process PH-Paramedic Hurtubise M, Stirling J, Greene J, Carter AJ, Swain J, Brown R, et al. Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review. Prehosp Disaster Med 2021; 36(6):730–8. Medline
I Supportive (Green) Time to GCS resolution Patient PH-Paramedic Moore C., Wollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg Med J 2005; 22:512-515 Medline
I Supportive (Green) Restoration of normal level of consciousness Patient ED-MD Patrick AW., Collier A., Hepburn DA., Steedman DJ., Clarke BF., Robertson C. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med 1990; 7(2):73-7. Medline
II Supportive (Green) Time to full orientation Patient PH-Paramedic Howell MA., Guly HR. A comparison of glucagon and glucose in prehospital hypoglycemia. J Accid Emerg Med 1997; 14:30-2. Medline
II Supportive (Green) Efficacy of restoring normoglycemia Patient PH-Paramedic Weant KA, Deloney L, Elsey G, Combs D, French D. A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting. J Pharm Pr 2021; 34(4):606–11. Medline
III Supportive (Green) Success Patient PH-Paramedic Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
III Neutral (Yellow) Response to D50W, appropriate diagnosis Patient PH-Paramedic Hoffman JR., Schriger DL., Votey SR., Luo JS. The empiric use of hypertonic dextrose in patients with altered mental status: A reappraisal. Ann Emerg Med 1992; 21(1):20-4. Medline

Glucagon
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time until full recovery Patient ED-MD Carstens S., Sprehn M. Prehospital treatment of severe hypoglycemia: A comparison of intramuscular glucagon and intravenous glucose. Prehos Dis Med 1998; 13(2):114-25. Medline
I Supportive (Green) Restoration of normal level of consciousness Patient ED-MD Patrick AW., Collier A., Hepburn DA., Steedman DJ., Clarke BF., Robertson C. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med 1990; 7(2):73-7. Medline
II Supportive (Green) Time to full orientation Patient PH-Paramedic Howell MA., Guly HR. A comparison of glucagon and glucose in prehospital hypoglycemia. J Accid Emerg Med 1997; 14:30-2. Medline
II Supportive (Green) Increase in BGL Patient PH-Paramedic Vermeulen MJ., Klompas M., Ray JG., Mazza C., Morrison LJ. Subcutaneous glucagon may be better than oral glucose for prehospital treatment of symptomatic hypoglycemia. Diabetes Care 2003; 26(8):2472-2473. Medline
III Supportive (Green) ED LOS Patient PH-Paramedic Ferrazzi S., Waltner-Toews D., Abernathy T., et al. The effects of prehospital advanced life support drug treatment on patient improvement and in-hospital utilization. Prehosp Emerg Care 2001; 5(3):252-60. Medline
III Supportive (Green) Correction of hypoglycemia Patient PH-Paramedic Haamid A, Christian E, Tataris K, Markul E, Zaidi HQ, Mycyk MB, Weber JM. Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care 2022:1–4. Medline
III Supportive (Green) Efficacy Patient PH-Paramedic Vukmir RB., Paris PM., Yealy DM. Glucagon: Prehospital therapy for hypoglycemia. Ann Emerg Med 1991; 20(4):375-379. Medline

Option to treat and release
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Bounce back Patient PH-Paramedic Anderson S., Hogskilde PD., Wetterslev J., et al. Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: A retrospective study. Acta Anaesthesiol Scand 2002; 46(4):464-8. Medline
II Supportive (Green) Repeat ambulance call, recurrence of hypoglycemia Process PH-Paramedic Cain E., Ackroyd-Stolarz S., Alexiadia P., Murray D. Prehospital hypoglycemia: the safety of not transporting treated patients. Prehospital Emergency Care 2003; 7:458-65. Medline
II Supportive (Green) Relapse within 3 days Process PH-Paramedic Carter AJ., Keane PS., Dreyer JF. Transport refusal by hypoglycemic patients after on-scene intravenous dextrose. Acad Emerg Med 2002; 9(8):855-7. Medline
II Supportive (Green) Relapse Patient PH-Paramedic Socransky SJ., Pirrallo RG., Rubin JM. Out-of-hospital treatment of hypoglycemia: Refusal of transport and patient outcome. Acad Emerg Med 1998; 5(11):1080-1085. Medline
III Supportive (Green) Transport to hospital Patient PH-Paramedic Khunti K., Fisher H., Paul S., Iqbal M., Davies MJ., Siriwardena AN. Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: A retrospective study. Prim Care Diabetes 2013; 7(2):159-65. Medline
III Supportive (Green) Safety Process PH-Paramedic Lerner EB., Billittier AJ 4th., Lance DR., Janicke DM., Teuscher JA. Can paramedics safely treat and discharge hypoglycemic patients in the field? Am J Emerg Med 2003; 21(2):115-20. Medline
III Supportive (Green) Efficacy Patient PH-Paramedic Mattila Elina M., Kuisma Markku J., Sund Kaj P., Voipio-Pulkki. Out-of-hospital hypoglycaemia is safely and cost-effectively treated by paramedics. European Journal of Emergency Medicine 2004; 11(2):70-4. Medline
III Supportive (Green) Recurrence of symptoms Patient PH-Paramedic Mechem CC., Kreshak AA., Barger J., Shofer FS. The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out of hospital therapy. Acad Emerg Med 1998; 5(8):768-72. Medline
III Supportive (Green) Patient preference Patient PH-Paramedic Steinmetz J., Nielsen SL., Rasmussen LS. Hypoglycaemia in patients with diabetes: do they prefer prehospital treatment or admission to hospital? Eur J Emerg Med 2006; 13(5):319-320. Medline
III Supportive (Green) Triage Process PH-Paramedic Strote J., Simmons R., Eisenberg M. EMT treatment of hypoglycemia without transport. Am J Emerg Med 2008; 26:291-5. Medline
III Supportive (Green) Success Patient PH-Paramedic Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
III Neutral (Yellow) Risk of repeat hypoglycemic events Patient PH-Paramedic Fitzpatrick D., Duncan EA. Improving post-hypoglycaemic patient safety in the prehospital environment: A systematic review. Emerg Med J 2009; 26(7):472-8. Medline

Oral Glucose
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Increase in BGL Patient PH-Paramedic Vermeulen MJ., Klompas M., Ray JG., Mazza C., Morrison LJ. Subcutaneous glucagon may be better than oral glucose for prehospital treatment of symptomatic hypoglycemia. Diabetes Care 2003; 26(8):2472-2473. Medline
III Supportive (Green) Safety Patient PH-Paramedic Steel JM., Allwinkle J., Moffat D., Carrington DJ. Use of Lucozade and glucagon by ambulance staff for treating hypoglycemia. BMJ 1992; 304:1283-4. Medline

Point of Care Blood Glucose Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Accuracy of rapid glucose testing Patient PH-Paramedic Holstein A., Kuhne D., Elsing HG., et al. Practicality and accuracy of prehospital rapid venous blood glucose determination. Am J Emerg Med 2000; 18(6):690-4. Medline
II Supportive (Green) Detection of hypoglycemia Process PH-Paramedic Lavery RF., Allegra JR., Cody RP., Zacharias D., Schreck DM. A prospective evaluation of glucose reagent test strips in the prehospital setting. Am J Emerg Med 1991; 9(4):304-8. Medline
II Supportive (Green) Sensitivity and specificity Process ED-MD Scott PA., Wolf LR., & Spadafora MP. Accuracy of reagent strips in detecting hypoglycemia in the emergency department. Ann Emerg Med 1998; 32(3):305-309. Medline
III Supportive (Green) Glucose value Process PH-Paramedic Jones JL., Ray VG., Gough JE., Garrison HG., Whitley TW. Determination of prehospital blood glucose: A prospective, controlled study. J Emerg Med 1992; 10(6):679-82. Medline
III Supportive (Green) Triage Process PH-Paramedic Strote J., Cloyd D., Rea T., Eisenberg M. The influence of emergency medical technician glucometry on paramedic involvement. Prehosp Emerg Care 2005; 9(3):318-321. Medline

Thiamine
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Changes in vital signs Patient PH-Paramedic Merlin MA. Comparison of Prehospital Glucose with or without IV Thiamine. West J Emerg Med 2012; 13(5):406-9. Medline


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