Comparison of the Effectiveness and Safety of 20% Versus 50% Glucose Solutions Administered by Paramedics to Patients With Hypoglycemia.

Aim: We aimed to compare the effectiveness and safety of 50% and 20% glucose solutions administered to patients with hypoglycemia in prehospital settings. Methods: This retrospective cohort study analyzed cases of hypoglycemia treated by paramedics with either 50% or 20% glucose solution (40 mL) between 2016 and 2023 in the Shida-Haibara district of Shizuoka Prefecture, Japan. The primary outcome was the degree of improvement in the Japan Coma Scale (JCS). Secondary outcomes were the blood glucose level at hospital arrival and the proportion of patients exhibiting JCS improvement, rebound hypoglycemia, need for in-hospital glucose administration, and adverse events. Results: A total of 242 patients met the inclusion criteria (131 and 111 in the 50% and 20% groups, respectively). The median initial blood glucose levels were similar (31 vs. 30 mg/dL), but they were significantly higher in the 50% group upon hospital arrival (151 vs. 81 mg/dL). The degree of JCS improvement did not differ significantly (4 vs. 3 grades). However, the proportion of patients with JCS improvement was higher in the 50% group (92% vs. 82%). Rebound hypoglycemia occurred in 15% and 9.0% of the patients, respectively (not statistically significant). In-hospital glucose administration was less frequent in the 50% group (42% vs. 75%). No soft tissue injuries were observed. Conclusion: The degree of JCS improvement did not differ significantly between the two groups; however, the 50% glucose solution was superior in some secondary outcomes.