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Exp Clin Endocrinol Diabetes 2022; 130(07): 454-461
DOI: 10.1055/a-1523-7562
Article

Out-of-Hospital Management of Diabetic Emergencies in Germany: Structural and Process Quality

David J.F. Holstein‡
1   Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Germany
,
Judith D. Holstein‡
2   Division of Nephrology and Internal Intensive Care Medicine, Charite’ University Medicine Berlin, Germany
,
Daniel Fischer
3   Department of Emergency Medicine, Lippe-Detmold Hospital, Germany
,
Meinhard Mende
4   Clinical Trial Centre and Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
,
Brian M. Frier
5   The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
,
Andreas Holstein
6   1st Department of Medicine, Lippe-Detmold Hospital, Germany
› Author Affiliations Funding Sources This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Abstract

Aims To collect and analyse representative data of structural and process quality in the management of diabetic emergencies in Germany in 2020.

Methods A standardised questionnaire comprising detailed items concerning clinically relevant parameters on the structural and process quality of out-of-hospital management of diabetic emergencies was sent nationwide to medical directors of emergency medical service districts (EMSDs). Results were compared with those from a similar study conducted in 2001.

Results The return rate of the questionnaires represented 126 EMSDs, serving a total population of > 40.1 million. Only 4% of ambulances carried glucagon (6% in 2001). In 2020, blood glucose determination increased significantly to 71% of all emergency interventions and to 29% of suspected cardiac emergencies (24% and 15%, respectively, in 2001). In 100% of EMSDs severe hypoglycaemia (SH) was treated by paramedics by administering intravenous dextrose before the arrival of a doctor compared to 63% in 2001. The potential value of nasal glucagon was acknowledged by 43% of responders. In selected patients, treatment of SH was conducted without hospital admission in 78% of EMDs (60% in 2001). Fifty-three percent of medical directors acknowledged the need for further training in diabetic emergencies (47% in 2001). Cooperation for medical education between emergency teams and a diabetes centre was reported by 14% (41% in 2001).

Conclusion Structural and process quality of the management of diabetic emergencies in Germany has improved considerably since 2001. Persisting deficiencies could be improved by providing better medical equipment in ambulances and ongoing education to the entire emergency teams.

Key words

Diabetes - emergency medicine - severe hypoglycaemia - process quality - structural quality

Supplementary Material



Publication History

Received: 11 March 2021
Received: 03 May 2021

Accepted: 28 May 2021

Article published online:
20 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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