Skip to main content

Advertisement

Log in

Predictors of hypoglycemia in hospitalized patients with diabetes mellitus

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Hypoglycemia is common among hospitalized patients with diabetes mellitus (DM), and is associated with increased morbidity and mortality. Identify pre-admission risk factors associated with in-hospital hypoglycemia. Historical prospectively collected data of adult DM patients hospitalized to medical wards between 2011 and 2013. Hypoglycemia and serious hypoglycemia were defined as at least one blood glucose measurement ≤ 70 and < 54 mg/dl, respectively, during hospitalization. The primary outcome was in-hospital hypoglycemia. The cohort included 5301 patients (mean age 73 ± 13 years, 51% male), including 792 patients (15%) with hypoglycemia, among them 392 patients (7%) with serious hypoglycemia. Patients with hypoglycemia or serious hypoglycemia during hospitalization were older, compared to patients without hypoglycemia and more likely to have chronic renal failure and cerebrovascular disease. Malignancy and female gender were risk factors for hypoglycemia, but not for serious hypoglycemia, while congestive heart failure was associated with increased risk only for serious hypoglycemia. Diabetes mellitus’ duration over 10 years was associated with an almost threefold increased risk for hypoglycemia, compared to DM duration less than a year. Insulin treatment and glycated hemoglobin > 9% were also more common in patients with hypoglycemia. Insulin treatment was associated with a fourfold increase in the risk for hypoglycemia among all glycated hemoglobin categories. Our results identified several risk factors for in-hospital hypoglycemia in patients with DM. These findings may lead to appropriate monitoring and early intervention to prevent hypoglycemia and to reduce morbidity and mortality associated with in-hospital hypoglycemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Turchin A, Matheny ME, Shubina M, Scanlon SV, Greenwood B, Pendergrass ML (2009) Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 32:1153–1157. https://doi.org/10.2337/dc08-2127

    Article  PubMed  PubMed Central  Google Scholar 

  2. Elliott MB, Schafers SJ, McGill JB, Tobin GS (2012) Prediction and prevention of treatment-related inpatient hypoglycemia. J Diabetes Sci Technol 6:302–309. https://doi.org/10.1177/193229681200600213

    Article  PubMed  PubMed Central  Google Scholar 

  3. Borzì V, Frasson S, Gussoni G, Di Lillo M, Gerloni R, Augello G et al (2016) Risk factors for hypoglycemia in patients with type 2 diabetes, hospitalized in internal medicine wards: findings from the FADOI-DIAMOND study. Diabetes Res Clin Pract 115:24–30. https://doi.org/10.1016/j.diabres.2016.01.020

    Article  PubMed  Google Scholar 

  4. Dendy JA, Chockalingam V, Tirumalasetty NN, Dornelles A, Blonde L, Bolton PM et al (2014) Identifying risk factors for severe hypoglycemia in hospitalized patients with diabetes. Endocr Pract 20:1051–1056. https://doi.org/10.4158/EP13467.OR

    Article  PubMed  Google Scholar 

  5. Eiland L, Goldner W, Drincic A, Desouza C (2014) Inpatient hypoglycemia: a challenge that must be addressed. Curr Diabetes Rep 14:1–9. https://doi.org/10.1007/s11892-013-0445-1

    Article  CAS  Google Scholar 

  6. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P et al (2011) Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 34:256–261. https://doi.org/10.2337/dc10-1407

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Varghese P, Gleason V, Sorokin R, Senholzi C, Jabbour S, Gottlieb JE (2007) Hypoglycemia in hospitalized patients treated with antihyperglycemic agents. J Hosp Med 2:234–240. https://doi.org/10.1002/jhm.212

    Article  PubMed  Google Scholar 

  8. Akirov A, Grossman A, Shochat T, Shimon I (2016) Mortality among hospitalized patients with hypoglycemia: insulin-related and non-insulin related. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2016-2653

    Google Scholar 

  9. Pieralli F, Bazzini C, Casati C, Fabbri A, Crociani A, Corradi F et al (2016) The classification of hospitalized patients with hyperglycemia and its implication on outcome: results from a prospective observational study in internal medicine. Intern Emerg Med 11:649–656. https://doi.org/10.1007/s11739-015-1358-6

    Article  PubMed  Google Scholar 

  10. American Diabetes Association (2016) Standards of medical care in diabetes—2016. Diabetes Care 37:14–80. https://doi.org/10.2337/dc14-S014

    Article  Google Scholar 

  11. American Diabetes Association (2017) Standards of medical care in diabetes—2017. Diabetes Care. https://doi.org/10.2337/dc14-s014

    Google Scholar 

  12. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD et al (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129–139. https://doi.org/10.1056/NEJMoa0808431

    Article  CAS  PubMed  Google Scholar 

  13. The Action to Control Cardiovascular Risk in Diabetes Study Group (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559

    Article  PubMed Central  Google Scholar 

  14. NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA et al (2012) Hypoglycemia and risk of death in critically ill patients. N Engl J Med 367:1108–1118. https://doi.org/10.1056/nejmoa1204942

    Article  Google Scholar 

  15. McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA (2012) Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care 35:1897–1901. https://doi.org/10.2337/dc11-2054

    Article  PubMed  PubMed Central  Google Scholar 

  16. Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A et al (2009) Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 180:821–827. https://doi.org/10.1503/cmaj.090206

    Article  PubMed  Google Scholar 

  17. Wiener RS, Wiener DC, Larson RJ (2008) Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 300:933–944. https://doi.org/10.1001/jama.300.8.933

    Article  CAS  PubMed  Google Scholar 

  18. Fischer KF, Lees JA, Newman JH (1986) Hypoglycemia in hospitalized patients. Causes and outcomes. N Engl J Med 315:1245–1250. https://doi.org/10.1056/NEJM198611133152002

    Article  CAS  PubMed  Google Scholar 

  19. Cook CB, Potter DJ, Kongable GL (2012) Characterizing glucose changes antecedent to hypoglycemic events in the intensive care unit. Endocr Pract 18:317–324. https://doi.org/10.4158/ep11215.or

    Article  PubMed  Google Scholar 

  20. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J et al (2010) The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ 340:b5444. https://doi.org/10.1136/bmj.b5444

    Article  PubMed  PubMed Central  Google Scholar 

  21. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367. https://doi.org/10.1056/NEJMoa011300

    Article  PubMed  Google Scholar 

  22. Rubin DJ, Rybin D, Doros G, McDonnell ME (2011) Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes. Diabetes Care 34:1723–1728. https://doi.org/10.2337/dc10-2434

    Article  PubMed  PubMed Central  Google Scholar 

  23. Arem R (1989) Hypoglycemia associated with renal failure. Endocrinol Metab Clin N Am 18:103–121

    CAS  Google Scholar 

  24. Jackson CL, Yeh H-C, Szklo M, Hu FB, Wang N-Y, Dray-Spira R et al (2014) Body-mass index and all-cause mortality in US adults with and without diabetes. J Gen Intern Med 29:25–33. https://doi.org/10.1007/s11606-013-2553-7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors have no conflicts of interest to disclose. The authors received no external funding for this study. A.A. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Authors and Affiliations

Authors

Contributions

AA substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. OA substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. HMI substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. TDC substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. TS substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. IS substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published.

Corresponding author

Correspondence to Amit Akirov.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of retrospective study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akirov, A., Amitai, O., Masri-Iraqi, H. et al. Predictors of hypoglycemia in hospitalized patients with diabetes mellitus. Intern Emerg Med 13, 343–350 (2018). https://doi.org/10.1007/s11739-018-1787-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-018-1787-0

Keywords

Navigation