Utilization of emergency services for severe hypoglycemia in people with diabetes in France: A study based on the national health insurance database

Aims: To estimate the number of people with diabetes (PWD) requiring emergency services for severe hypoglycemia (SH) in France and the associated costs. Methods: PWD were identified using the National Health Insurance database (SNDS). Type of diabetes was determined by the medications used. Matching of the emergency department (ED) visits database (RPU) and the SNDS was used to identify ED visits for SH in 2016 and 2017. SH was identified in the RPU using specific ICD-10 codes. The main SH-related costs analyzed were costs of ED visits, hospitalization, and transport. Results: Of 3,236,600 PWD in 2017, 781,084 had at least one ED visit (11.5% type 1 diabetes [T1D]) and 9,160 patients had at least one ED visit for SH (40.2% T1D; 55.9% male; mean age 63.0 years; mean diabetes duration 17.2 years). Nearly 50% of ED visits for SH led to immediate hospitalization. The total cost of emergency services for SH was €12.39 million. The mean (SD) cost per patient was €1,352 (€2,540). Conclusions: SH accounts for nearly 1% of ED visits in PWD, and nearly half of these patients are hospitalized during the visit. Beyond the patient impact, SH is associated with a substantial economic burden.