Unintentional Therapeutic Errors Involving Insulin in the Ambulatory Setting Reported to Poison Centers

Adverse drug events in the ambulato-ry care setting are not uncommon and can cause significant morbidity.1-4 Insulin is one of the leading medications involved in adverse drug events leading to an emergency department visit, espe-cially in older adults.2 However, the pub-lished data on insulin adverse drug events have focused primarily on the hospital setting.1-4 There is a lack of in-formation on the epidemiology of in-sulin-associated adverse drug events in the ambulatory care or non–hospital-based setting. One study of a poisons unit in Germany found that 5 % of in-sulin overdoses were accidental, and 90 % of the cases were intentional suici-dal insulin overdose, with all inquiries coming from the physician caring for the patient, suggesting these cases were not being managed in the ambulatory set-ting.5 In the US, poison control centers are able to manage the majority of their pa-tients in the ambulatory care setting, of-ten reducing the need for an unnecessary emergency department visit.6,7 Poison control centers manage more than 200,000 adverse drug events annually, with 88 % of these patients managed out-side of the hospital setting.3,7 The real-time database of these centers would b