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Hypoglycemia- simplifying the ways to predict an old problem in the general ward

Published:November 28, 2018DOI:https://doi.org/10.1016/j.ejim.2018.10.007

      Highlights

      • Blood sugar is often unstable among hospitalized patients with diabetes.
      • 18.5% of patients with diabetes had hypoglycemia; 83% had mild-to-moderate values.
      • 30-day mortality post-discharge was higher in mild/moderate or severe hypoglycemia.
      • One-year mortality was higher among those with hypoglycemia.
      • Hypoglycemia was related to hemoglobin and albumin < normal or creatinine > normal.

      Abstract

      Objective

      To examine the association between hypoglycemic events and inpatient and outpatient mortality rates, and to characterize the profile of patients with diabetes who develop hypoglycemia during hospitalization in order to identify risk factors and potentially avoid it.

      Research design and methods

      This retrospective cohort study analyzed data of 3410 patients with diabetes hospitalized during 2012. The associations among biochemical measures, severity of hypoglycemia, inpatient length of stay, and mortality during hospitalization, one month and within one year after discharge were evaluated.

      Results

      Hypoglycemia was observed in 18.5% (633/3410) of patients with diabetes, 83% (529/633) with mild/moderate hypoglycemic values. Adjusted for age and sex, the 30-day mortality rate after discharge was higher in the group with mild/moderate hypoglycemia (HR = 1.749, CI 1.288–2.374, p < 0.001) and in the group with severe hypoglycemia (HR = 3.390, CI 2.332–6.100, p < 0.001). The mortality rate at the one-year follow-up was higher in the group with mild/moderate hypoglycemia (HR = 1.749, CI 1.288–2.374, p < 0.001) and in the group with severe hypoglycemia (HR = 3.390, CI 2.332–6.100, p < 0.001).
      In multivariate analysis, hemoglobin and albumin below normal values, and creatinine values above the upper limit were strongly associated with hypoglycemia (OR 1.35, 95%CI 1.1–1.6, p < 0.03; OR 1.6, 95%CI 1.33–1.89, p < 0.001; OR 1.3, 95%CI 1.08–1.55, p < 0.04, respectively).

      Conclusions

      Hospitalized patients with diabetes and low hemoglobin, low albumin or high creatinine levels are at increased risk of developing significant hypoglycemia. Identifying accurate high-risk factors in order to intervene early and efficiently can prevent life-threatening complications.

      Keywords

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