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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Article info
Publication history
Published online: November 28, 2018
Accepted:
October 14,
2018
Received in revised form:
October 12,
2018
Received:
June 28,
2018
Identification
Copyright
© 2018 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
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- Risk of hypoglycemia in hospitalized patients with diabetes mellitusEuropean Journal of Internal MedicineVol. 62
