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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0905" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0905" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes mellitus &#40;DM&#41; is a disease with a high healthcare impact&#44; not only for its high prevalence but also for the chronic complications it causes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and its high mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The prevalence of DM is increasing&#59; the World Health Organization &#40;WHO&#41; estimates that by 2030 there will be 366 million diabetics worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This significant increase is attributed to the growth and aging of the population&#44; the increased frequency of obesity and a lack of physical exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In Spain&#44; the prevalence of type 1 DM is estimated to vary between 0&#46;08&#37; and 0&#46;2&#37;&#44; while the prevalence of type 2 DM varies between 4&#46;8&#37; and 18&#46;7&#37;&#44; depending on the region and age group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the most common complications of treatment is hypoglycemia&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> whose symptoms vary from the very mild to the severe&#44; which requires hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Hypoglycemic episodes are an important limiting factor for achieving treatment objectives in patients with diabetes<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and is associated with an increased mortality rate<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and a negative impact on the quality of life of patients with diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The incidence of severe hypoglycemia in patients with type 2 DM depends on factors such as the treatment used and the age group of the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Several studies have estimated the prevalence and incidence of this complication with differing results&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;12&#8211;14</span></a> However&#44; there are very few studies that have attempted to estimate the incidence of hospitalization episodes for hypoglycemia in patients with type 2 DM&#44; and none have been published in Spain to date&#46; The primary aim of this study was to estimate the annual number of hospitalizations for severe hypoglycemia in patients with type 1 and type 2 DM in the National Health System &#40;NHS&#41; of Spain and by autonomous community &#40;AC&#41;&#46;</p></span><span id="sec0710" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a retrospective study that calculated the annual number of hospital admissions for severe hypoglycemia that required hospitalization in patients with type 1 and type 2 DM throughout Spain and by AC&#46; The study focused on hospitalizations for severe hypoglycemia in general and public hospitals throughout Spain&#46; To establish the universe of hospitals for the study&#44; the 2007 National Catalog of Hospitals &#40;NCH&#41; was used as a starting point &#40;the most recently available information at the time of the study&#41;&#44; with information on 799 national hospital centers&#46; Of the 799 centers in the NCH&#44; we selected those with &#8220;general&#8221; objectives&#44; reducing the previous group to 534 hospitals&#46; &#8220;General&#8221; hospitals were all those assigned to the care of patients affected by any number of diseases and that cover the areas of medicine&#44; surgery&#44; obstetrics&#44; gynecology and pediatrics&#46; Centers that had a public institution ownership structure were selected directly&#46; Of the remaining hospitals &#40;most of them private&#41;&#44; we selected those that were linked to the competent health authorities&#46; Therefore&#44; the total number of hospitals included in the study universe was 260&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study population was composed of patients with type 1 and type 2 DM who had experienced episodes of severe hypoglycemia&#44; defined as a hypoglycemic episode that required hospitalization&#44; according to the doctor on call who treated and admitted the patient&#46; We included episodes of hospitalization where the primary diagnosis was hypoglycemia in patients with diabetes as well as the episodes where the hypoglycemia in patients with diabetes was one of the secondary diagnoses&#46; We defined the primary diagnosis as the condition that motivated the hospitalization and the secondary diagnosis as the diagnosis that coexisted with the primary diagnosis at the time of hospitalization or that developed over the course of the hospital stay and that influenced the duration of the hospital stay or the administered treatment&#46; We included in the analysis all hospital admissions in which the primary or secondary diagnosis recorded was one of the following codes in the International Classification of Diseases &#40;9th edition&#44; clinical modification&#44; ICD-9-CM&#41;&#58; 250&#46;80 &#40;diabetes with other uncompensated type 2 manifestations&#44; including diabetic hypoglycemia and hypoglycemic shock&#41;&#59; 250&#46;82 &#40;diabetes with other decompensated type 2 manifestations&#41;&#59; 250&#46;81 &#40;diabetes with other uncompensated type 1 manifestations&#44; including diabetic hypoglycemia and hypoglycemic shock&#41; and 250&#46;83 &#40;diabetes with other decompensated type 1 manifestations&#41; and 250&#46;8&#42; &#40;with no fifth digit to detect nonspecific cases&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The calculation of the incidence of hospitalization episodes for severe hypoglycemia was performed based on the analysis of the information contained in the Minimum Basic Data Set &#40;MBDS&#41; database for the period January 1 to December 31&#44; 2007&#46; To access the information reported in the MBDS&#44; we used the Projected Hospitalization of IASIST&#46; This database collects information of actual hospital discharges from 183 of the 260 &#40;70&#37;&#41; Spanish &#8220;general&#8221; and &#8220;public&#8221; hospitals that treat patients of the NHS&#46; To calculate the activity of the 77 remaining hospitals not included in the MBDS&#44; we collected information on the total number of discharges treated at these centers from alternative official sources&#44; such as the websites of these hospitals&#44; the Andalusian Health Service website&#44; the Madrid Health Institute website and Galician Health Service website &#40;See Websites Consulted in the Appendix of the online version&#41;&#46; This process allowed us to obtain information on the hospitalization activity figures &#40;total number of discharges&#41; of 59 hospitals&#46; For the 18 remaining hospitals &#40;representing only 6&#46;9&#37; of the total number of hospitals&#41;&#44; we calculated the total hospitalization activity &#40;total number of discharges&#41;&#46; Based on the 242 hospitals with information on the number of beds and the number of hospitalizations in 2007&#44; we developed 5 simple linear regression models &#40;1 for each hospital level&#41;&#44; with the number of hospitalizations as the variable dependent on the number of beds&#46; We considered the number of beds as the independent variable&#44; given that it is the factor most closely linked to the number of hospitalizations in a center &#40;Pearson correlation coefficient of 0&#46;97&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The calculations enabled us to determine the total number of hospitalizations in the general hospitals of the NHS&#44; which came to a total of 3&#44;763&#44;452 hospitalizations&#44; from which we excluded hospitalizations for obstetric activities &#40;major diagnostic criteria 14&#58; pregnancy&#44; delivery and postpartum&#41;&#44; obtaining a total of 3&#44;254&#44;464 hospitalizations&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Once we had established the census of general public hospitals and their respective volumes of hospitalization activity&#44; we calculated the caseload of the 77 hospitals not included in the MBDS&#46; The calculation of this caseload takes priority over the calculation by hospital level and by AC&#59; i&#46;e&#46;&#44; when the representativeness of the original data permitted&#44; we calculated the caseload of the hospital based on the caseload of hospitals of the same level in that AC&#46; The information on a specific level of hospital and AC was considered representative if at least 50&#37; of the hospitals were available &#40;as long as there were at least 3 hospitals per level and AC&#41;&#46; The caseload of a total of 19 centers was calculated using the above criteria&#46; In cases where the calculation could not be made by hospital level and AC &#40;59 hospitals&#41;&#44; the hospital&#39;s caseload was estimated by considering all national hospitals of the same level&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The caseload was determined by applying the percentage distribution by All Patient Diagnosis Related Group &#40;AP-DRG version 21&#46;0&#41; of the original pertinent set &#40;hospitals of the same level and AC or hospitals of the same national level&#44; as described above&#41; to the volume of hospitalizations of each hospital whose caseload is being calculated&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#40;available in online Appendix&#41; shows the representativeness of the database of hospitalizations by AC&#46; The numbers shown in the figure correspond to the percentage of hospitals of each AC for which information was obtained using each of the 3 sources &#40;MBDS&#44; website and the rest of the NHS&#41;&#46; To put this data into context&#44; we determined the total number of hospitalizations for diabetes in general based on the 2007 Survey of Hospital Morbidity&#44; according to which the total number of hospitalizations of patients with diabetes in the NHS was 33&#44;823&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The total number of hospitalizations in the general hospitals of the NHS rose to 3&#44;254&#44;464 episodes in 2007&#46; The total number of admissions for severe hypoglycemia was 26&#44;701 &#40;0&#46;82&#37; of the total admissions&#41;&#44; of which 9399 &#40;0&#46;29&#37; of the total admissions&#41; corresponded to a primary diagnosis and 17&#44;703 &#40;0&#46;51&#37; of the total admissions&#41; to a secondary diagnosis&#46; Among the patients with type 2 DM there were 8242 &#40;0&#46;25&#37;&#41; hospitalizations where severe hypoglycemia was the primary diagnosis and 16&#44;649 &#40;0&#46;51&#37;&#41; hospitalizations where it was the secondary diagnosis&#46; Among the patients with type 1 DM there were 1157 &#40;0&#46;04&#37;&#41; hospitalizations where severe hypoglycemia was the primary diagnosis and 653 &#40;0&#46;02&#37;&#41; hospitalizations where it was the secondary diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Therefore&#44; the episodes in patients with type 2 DM accounted for 87&#46;7&#37; &#40;8242 of 9399&#41; of the hospitalizations where severe hypoglycemia was the primary diagnosis in patients with diabetes&#46; In the patients with type 2 DM&#44; it was also observed that the prevalence of hospitalizations for severe hypoglycemia was 35&#46;3&#37; &#40;8242 of 23&#44;343&#41; in terms of the total number of hospitalizations with type 2 DM as the primary diagnosis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">When both the primary and secondary diagnoses are considered&#44; we observe that hospitalization for severe hypoglycemia in patients with type 2 DM had a prevalence of 5&#46;01&#37; &#40;24&#44;891 of 496&#44;660&#41; in the total number of episodes&#44; in which the diagnosis of type 2 DM &#40;primary and&#47;or secondary&#41; was present&#46; In type 1 DM&#44; hospitalizations for severe hypoglycemia represented a prevalence of 6&#46;34&#37; &#40;1810 of 28&#44;541&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We did not identify episodes in which the diagnosis was nonspecific hypoglycemia for the type of DM&#59; therefore&#44; extrapolation of these cases was not necessary&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the number of hospitalization episodes in each AC&#44; with severe hypoglycemia as the primary or secondary diagnosis in patients with type 1 or type 2 DM&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the case of severe hypoglycemia as the primary &#40;1477 episodes&#41; or secondary &#40;3836 episodes&#41; diagnosis&#44; we observed that Catalonia is the AC with the highest number of hospital admissions for this event in patients with type 2 DM&#44; with 17&#46;9&#37; and 23&#46;0&#37; of the total number of episodes&#44; respectively&#46; The AC with the lowest number of episodes was Ceuta y Melilla&#44; with 26 &#40;0&#46;3&#37;&#41; and 30 &#40;0&#46;2&#37;&#41; admissions&#44; depending on whether the diagnosis was primary or secondary&#44; respectively&#46; A similar pattern was observed when we calculated the number and proportion of episodes of hospitalization for severe hypoglycemia in patients with type 1 DM&#44; with a total of 262 hospitalizations in Catalonia and only 2 hospitalizations in Ceuta y Melilla&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the incidence of hospital episodes due to hypoglycemia&#44; in terms of the general population&#44; as the primary diagnosis in patients with type 2 DM in terms of admissions per 10&#44;000 inhabitants per year throughout Spain and by AC&#46; Overall&#44; the incidence was calculated at 1&#46;82 episodes per 10&#44;000 inhabitants per year&#46; The AC with the highest incidence of hospitalization episodes per inhabitant was Castilla y Le&#243;n&#44; with 3&#46;37 episodes per 10&#44;000 inhabitants per year&#46; The AC with the lowest incidence of hospitalization for severe hypoglycemia was the Canary Islands&#44; with 1&#46;10 episodes per 10&#44;000 inhabitants per year&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The results of this study show for the first time that hospitalizations in Spain with hypoglycemia as the primary diagnosis represent 24&#46;4&#37; of the total number of hospitalizations in patients with type 2 DM&#46; We have not found any studies in the literature with a similar methodology for an appropriate comparison of the results&#46; However&#44; this figure is similar to that measured in a prospective study performed in Italy with elderly patients &#40;&#8805;80 years of age&#41; with type 2 DM&#44; which estimated that 25&#37; of hospital admissions associated with diabetes were due to severe hypoglycemia&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However&#44; this percentage may be slightly overestimated due to the inclusion of diagnostic criteria that could correspond to other DM decompensations&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With respect to the variability in hospitalization rates between ACs&#44; the incidence rate in Castilla y Le&#243;n is approximately 3 times higher than the rate in the Canary Islands&#44; which has the lowest rate for all ACs&#46; This type of variability has been observed in previous studies on other diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> To interpret the differences between ACs&#44; we should take into account that for some ACs the low percentage of actual data may lead to biases in the calculation&#46; The differences in terms of hypoglycemia incidence between ACs are not correlated with the differences reported in terms of DM prevalence&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This is due to the fact that hypoglycemia is a complication of DM treatment and not of the actual disease&#44; and is more common in patients who are administered insulin and&#47;or sulfonylureas&#46; The incidence of hospitalizations for severe hypoglycemia is related to the treatment received by patients and with the degree of control of their disease&#59; therefore&#44; we can expect the incidence to be more dependent on the clinical handling of patients than on the prevalence of DM in each AC&#46; The clinical specialties that perform the diagnosis and clinical management of patients with diabetes can vary between ACs&#46; Diabetologists&#44; endocrinologists&#44; internists and even the primary care physician can be involved&#44; each with a different level of specialization&#44; training and experience in the disease&#46; There are also numerous currently available clinical practice guidelines and consensus documents&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;25</span></a> The differences between ACs could also be related to the use of different methods for obtaining or estimating the number of hospitalizations for hypoglycemia in each AC&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This study identified a high number of episodes in which severe hypoglycemia in patients with diabetes was found to be the secondary diagnosis&#46; However&#44; we should take into account that although hypoglycemia was recorded as a secondary diagnosis&#44; it could have been related to the hospitalization of the patient or could have triggered the reason for the admission&#46; In fact&#44; a number of international studies have associated the occurrence of cardiovascular events with hypoglycemic episodes in patients with diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> Therefore&#44; it is possible that the number of hospitalizations in which severe hypoglycemia plays an important role or can be considered one of the causes of the admission remains underestimated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">One of the limitations of this study is the database used to calculate the number of hospitalizations for severe hypoglycemia &#40;the MBDS&#41;&#44; because it does not allow for the differentiation of episodes in which the secondary diagnosis of hypoglycemia was recorded at the time of admission or during the patient&#39;s hospital stay&#46; Additionally&#44; the MBDS can present inconsistencies in the coding of hospital discharges in the assignment of the primary diagnosis and in consideration of the secondary diagnoses or accompanying comorbidities&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> as well as an under-reporting of severe hypoglycemia&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The data recorded in this study indicate that a significant number of hospitalizations for severe hypoglycemia occur in Spain&#46; Data from international literature indicate that cases of hypoglycemia that require hospitalization are mostly highly severe episodes&#44; which can represent a high economic impact in the treatment of type 2 DM&#46; Therefore&#44; new prospective studies that evaluate the clinical consequences and costs of hypoglycemia episodes at the various levels of severity are warranted to measure the actual impact of this significant complication for patients with diabetes in Spain&#46; It would also be interesting to further explore the causes of the probable variability in the hospitalization rates for this cause among the ACs observed in this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This research has been sponsored by <span class="elsevierStyleGrantSponsor" id="gs0005">Bristol-Myers Squibb and AstraZeneca</span>&#59; however&#44; the analysis has been performed independently by the authors&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">Dr&#46; R&#46; Garc&#237;a-S&#225;nchez works as managing doctor of the Cardiovascular and Metabolism Area of Bristrol-Myers Squibb Spain&#59; C&#46; &#193;lvarez works in the Pharmacoeconomics Area of AstraZeneca Pharmaceutical Spain&#44; S&#46;A&#46;&#59; and L&#46; Beteg&#243;n works in the Economy of Health Area of Bristol-Myers Squibb Spain&#46;</p></span></span>"
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            0 => "Resumen"
            1 => "Antecedentes y objetivo"
            2 => "Pacientes y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
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    "fechaRecibido" => "2013-01-31"
    "fechaAceptado" => "2013-02-22"
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            0 => "Hypoglycemia"
            1 => "Diabetes mellitus"
            2 => "National Health System"
            3 => "Hospitalizations"
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          "palabras" => array:4 [
            0 => "Hipoglucemia"
            1 => "Diabetes mellitus"
            2 => "Sistema Nacional de Salud"
            3 => "Hospitalizaciones"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">One of the most important therapeutic complications in patients with diabetes mellitus &#40;DM&#41; is hypoglycemia&#46; This study has estimated the number of hospitalizations due to severe hypoglycemia in patients with type DM1 and DM2&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study hospital population was defined using the National Catalog of Hospitals &#40;CNH&#41; 2007 &#40;last available data&#41;&#44; and has included 260 general hospitals of the National Health System&#46; The number of hospitalizations due to severe hypoglycemia was obtained from the Basic Minimum Data Set &#40;BMDS&#41; for the 183 hospitals&#46; For the remaining 77 hospitals&#44; this number was estimated based on the available information&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 2007&#44; there were 26&#44;701 &#40;0&#46;82&#37;&#41; hospitalizations with hypoglycemia&#46; In DM2 patients&#44; 8242 &#40;0&#46;25&#37;&#41; episodes were reported as primary diagnosis and 16&#44;649 &#40;0&#46;51&#37;&#41; as secondary&#46; In DM1 patients&#44; 1157 &#40;0&#46;04&#37;&#41; and 653 &#40;0&#46;02&#37;&#41; episodes were reported as primary and secondary diagnosis&#44; respectively&#46; Overall incidence in DM2 was 1&#46;82 episodes&#47;10&#44;000 inhabitants-year&#44; this ranging between 1&#46;10 episodes&#47;10&#44;000 inhabitants-year in the Islas Canarias to 3&#46;37 in Castilla y Le&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Severe hypoglycemia is an important reason for hospitalization of patients with DM in Spain&#44; there being great variability according to the Autonomous Regions&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Una de las complicaciones terap&#233;uticas m&#225;s importantes en los pacientes con diabetes mellitus &#40;DM&#41; es la hipoglucemia&#46; Hemos estimado el n&#250;mero de hospitalizaciones por hipoglucemia grave en los pacientes con DM tipo 1 &#40;DM1&#41; y tipo 2 &#40;DM2&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El universo hospitalario se defini&#243; a partir del Cat&#225;logo Nacional de Hospitales &#40;CNH&#41; de 2007 &#40;&#250;ltimos datos disponibles&#41;&#44; y se incluyeron 260 hospitales generales del Sistema Nacional de Salud&#46; El n&#250;mero de hospitalizaciones por hipoglucemia grave fue extra&#237;do del Conjunto M&#237;nimo B&#225;sico de Datos &#40;CMBD&#41; para 183 hospitales&#46; Para los 77 restantes se estim&#243; a partir de la informaci&#243;n disponible&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el a&#241;o 2007 se produjeron un total de 26&#46;701 &#40;0&#44;82&#37;&#41; hospitalizaciones con hipoglucemia&#46; En los enfermos con DM2 se reportaron 8&#46;242 &#40;0&#44;25&#37;&#41; ingresos como diagn&#243;stico principal y 16&#46;649 &#40;0&#44;51&#37;&#41; como secundario&#46; En los pacientes con DM1 se reportaron 1&#46;157 &#40;0&#44;04&#37;&#41; y 653 &#40;0&#44;02&#37;&#41; ingresos como diagn&#243;stico principal y secundario&#44; respectivamente&#46; La incidencia global en DM2 fue de 1&#44;82 episodios&#47;10&#46;000 habitantes&#47;a&#241;o&#44; y oscil&#243; entre los 1&#44;10 episodios&#47;10&#46;000 habitantes&#47;a&#241;o en Canarias y los 3&#44;37 episodios en Castilla y Le&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La hipoglucemia grave es una causa importante de hospitalizaci&#243;n en los pacientes con DM en Espa&#241;a&#44; con una gran variabilidad entre <span class="elsevierStyleSmallCaps">CCAA</span>&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Lindner L&#44; Garc&#237;a-S&#225;nchez R&#44; Alvarezc C&#44; Beteg&#243;n L&#44; Badia X&#46; Hospitalizaciones por hipoglucemia grave en pacientes con diabetes mellitus en Espa&#241;a&#46; Rev Clin Esp&#46; 2013&#59;213&#58;370&#8211;376&#46;</p>"
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            "apendice" => "<p id="par0120" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0040"
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2239
            "Ancho" => 1603
            "Tamanyo" => 249124
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of hospitals in each Autonomous Community &#40;AC&#41; in which the information was obtained using 1 of 3 sources &#40;MBDS&#44; Website&#44; and the rest of the National of Health System &#91;NHS&#93;&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 925
            "Ancho" => 1594
            "Tamanyo" => 132048
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Incidence by Autonomous Community of Spain in hospitalizations for severe hypoglycemia in patients with type 2 DM&#58; admissions for every 10&#44;000 inhabitants per year&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; Data extrapolated from the MBDS and the 2007 Survey of Hospital Morbidity&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hospitalizations in the NHS in 2007 &#40;total cases<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;254&#44;464&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ICD-9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Primary admission diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Secondary admission diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type 2 diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">473&#44;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type 1 diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoglycemia in patients with type 2 DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&#46;80 or 250&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;649&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoglycemia in patients with type 1 DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&#46;81 or 250&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">653&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoglycemia in patients with unspecified diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab418285.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">With no fifth digit to detect unspecified cases&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The number of hospitalizations where severe hypoglycemia was the primary or secondary diagnosis in the National Health System &#40;NHS&#41; of Spain during 2007&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; Data extrapolated from the MBDS and the 2007 Survey of Hospital Morbidity&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AC&#58; autonomous community&#59; MBDS&#58; minimum basic data set&#59; type 1&#59; DM&#58; type 1 diabetes mellitus&#59; type 2&#59; DM&#58; type 2 diabetes mellitus&#59; NHS&#58; National Health System &#40;Spain&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total number of hospitalization episodes of the NHS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hypoglycemia in patients with type 1 DM as the primary diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hypoglycemia in patients with type 1 DM as the secondary diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hypoglycemia in patients with type 2 DM as the primary diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hypoglycemia in patients with type 2 DM as the secondary diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of episodes &#40;percentage of total&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of episodes &#40;percentage of total&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of episodes &#40;percentage of total&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of episodes &#40;percentage of total&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Catalonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;210&#44;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">541&#44;658&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">262 &#40;22&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146 &#40;22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1477 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3836 &#40;23&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;885&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&#44;850&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1165 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1460 &#40;8&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Andalusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;059&#44;461&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">512&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;14&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1089 &#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2375 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castilla y Le&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;528&#44;417&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">244&#44;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">851 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1362 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;081&#44;689&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">390&#44;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">821 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2420 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basque Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;141&#44;860&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164&#44;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">461 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">878 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Murcia &#40;Region of&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;392&#44;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#44;898&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">451 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">361 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;772&#44;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&#44;739&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">426 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">841 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;977&#44;304&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141&#44;602&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">270 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">888 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Canary Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;025&#44;951&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#44;567&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">222 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">374 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Balearic Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;030&#44;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">259 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asturias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;074&#44;862&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&#44;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">264 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aragon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;296&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#44;624&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">386 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cantabria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">572&#44;824&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations with severe hypoglycemia as the primary or secondary diagnosis in patients with diabetes by AC&#46;</p>"
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        "tipo" => "MULTIMEDIATEXTO"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0865">What we know&#63;</span><p id="par0910" class="elsevierStylePara elsevierViewall">Hypoglycemia is a significant treatment complication in patients with type 1 or 2 diabetes mellitus&#46; The number of hospitalizations in Spain as a result of this adverse effect are not known&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0870">What this article provides&#63;</span><p id="par0815" class="elsevierStylePara elsevierViewall">In 2007 &#40;latest available information&#41;&#44; more than 26&#44;000 patients with hypoglycemia were hospitalized in Spain &#40;0&#46;82&#37; of all hospitalizations&#41;&#46; The overall incidence was 1&#46;10 episodes for every 10&#44;000 inhabitants per year&#46; There was considerable disparity among the autonomous communities &#40;ACs&#41; &#40;highest in Castilla y Le&#243;n &#91;3&#46;37 episodes&#93; and lowest in the Canary Islands &#91;1&#46;10 episodes&#93;&#41;&#46;</p><p id="par0850" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
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                    0 => array:2 [
                      "titulo" => "Complicaciones cr&#243;nicas en la diabetes mellitus tipo 1&#46; An&#225;lisis de una cohorte de 291 pacientes con un tiempo medio de evoluci&#243;n de 15 a&#241;os"
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                            3 => "I&#46; Castells"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46; Wild"
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                        "tituloSerie" => "Diabetes Care"
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                    0 => array:2 [
                      "titulo" => "La diabetes mellitus en Espa&#241;a&#58; mortalidad&#44; prevalencia&#44; incidencia&#44; costes econ&#243;micos y desigualdades"
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                        0 => array:2 [
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                            0 => "M&#46; Ruiz-Ramos"
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                            2 => "E&#46; Mayoral-S&#225;nchez"
                            3 => "F&#46; Corral-San Laureano"
                            4 => "I&#46; Fern&#225;ndez-Fern&#225;ndez"
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Gac Sanit"
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                      "titulo" => "Implications of the United Kingdom prospective diabetes study"
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                            0 => "C&#46;D&#46; Miller"
                            1 => "L&#46;S&#46; Phillips"
                            2 => "D&#46;C&#46; Ziemer"
                            3 => "D&#46;L&#46; Gallina"
                            4 => "C&#46;B&#46; Cook"
                            5 => "I&#46;M&#46; El-Kebbi"
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Journal Information
Vol. 213. Issue 8.
Pages 370-376 (November 2013)
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Vol. 213. Issue 8.
Pages 370-376 (November 2013)
Original article
Hospitalizations due to severe hypoglycemia in patients with diabetes mellitus in Spain
Hospitalizaciones por hipoglucemia grave en pacientes con diabetes mellitus en España
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L. Lindnera, R. García-Sánchezb, C. Alvarezc, L. Betegónd, X. Badiaa,
Corresponding author
xbadia@es.imshealth.com

Corresponding author.
a HEOR-IMS Health, Barcelona, Spain
b Cardiovascular y Metabolismo, Bristol-Myers Squibb, Madrid, Spain
c Farmacoeconomía, AstraZeneca, Madrid, Spain
d Economía de la Salud, Bristol-Myers Squibb, Madrid, Spain
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Tables (2)
Table 1. The number of hospitalizations where severe hypoglycemia was the primary or secondary diagnosis in the National Health System (NHS) of Spain during 2007.
Table 2. Hospitalizations with severe hypoglycemia as the primary or secondary diagnosis in patients with diabetes by AC.
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Abstract
Background and objectives

One of the most important therapeutic complications in patients with diabetes mellitus (DM) is hypoglycemia. This study has estimated the number of hospitalizations due to severe hypoglycemia in patients with type DM1 and DM2.

Patients and methods

The study hospital population was defined using the National Catalog of Hospitals (CNH) 2007 (last available data), and has included 260 general hospitals of the National Health System. The number of hospitalizations due to severe hypoglycemia was obtained from the Basic Minimum Data Set (BMDS) for the 183 hospitals. For the remaining 77 hospitals, this number was estimated based on the available information.

Results

In 2007, there were 26,701 (0.82%) hospitalizations with hypoglycemia. In DM2 patients, 8242 (0.25%) episodes were reported as primary diagnosis and 16,649 (0.51%) as secondary. In DM1 patients, 1157 (0.04%) and 653 (0.02%) episodes were reported as primary and secondary diagnosis, respectively. Overall incidence in DM2 was 1.82 episodes/10,000 inhabitants-year, this ranging between 1.10 episodes/10,000 inhabitants-year in the Islas Canarias to 3.37 in Castilla y León.

Conclusions

Severe hypoglycemia is an important reason for hospitalization of patients with DM in Spain, there being great variability according to the Autonomous Regions.

Keywords:
Hypoglycemia
Diabetes mellitus
National Health System
Hospitalizations
Resumen
Antecedentes y objetivo

Una de las complicaciones terapéuticas más importantes en los pacientes con diabetes mellitus (DM) es la hipoglucemia. Hemos estimado el número de hospitalizaciones por hipoglucemia grave en los pacientes con DM tipo 1 (DM1) y tipo 2 (DM2).

Pacientes y métodos

El universo hospitalario se definió a partir del Catálogo Nacional de Hospitales (CNH) de 2007 (últimos datos disponibles), y se incluyeron 260 hospitales generales del Sistema Nacional de Salud. El número de hospitalizaciones por hipoglucemia grave fue extraído del Conjunto Mínimo Básico de Datos (CMBD) para 183 hospitales. Para los 77 restantes se estimó a partir de la información disponible.

Resultados

En el año 2007 se produjeron un total de 26.701 (0,82%) hospitalizaciones con hipoglucemia. En los enfermos con DM2 se reportaron 8.242 (0,25%) ingresos como diagnóstico principal y 16.649 (0,51%) como secundario. En los pacientes con DM1 se reportaron 1.157 (0,04%) y 653 (0,02%) ingresos como diagnóstico principal y secundario, respectivamente. La incidencia global en DM2 fue de 1,82 episodios/10.000 habitantes/año, y osciló entre los 1,10 episodios/10.000 habitantes/año en Canarias y los 3,37 episodios en Castilla y León.

Conclusiones

La hipoglucemia grave es una causa importante de hospitalización en los pacientes con DM en España, con una gran variabilidad entre CCAA.

Palabras clave:
Hipoglucemia
Diabetes mellitus
Sistema Nacional de Salud
Hospitalizaciones

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