Hypoglycemia and Clinical Outcomes in Hospitalized Patients With Diabetes: Does Association With Adverse Outcomes Remain When Number of Glucose Tests Performed Is Accounted For?

Abstract

Background: Hypoglycemia is associated with increased length of stay in hospital patients, but previous studies have not considered the confounding effect of increased hypoglycemia detection associated with increased capillary blood glucose (CBG) measurement in prolonged admissions. We aimed to determine the effect of recorded hypoglycemia on length of stay of hospital inpatients (LOS) when this mathematical association is subtracted. Methods: CBG data were analyzed for inpatients within our health board area (01/2009-01/2015). A simulated CBG data set was generated for each patient with an identical sampling frequency to the measured CBG data set. The mathematical component of increased LOS was determined using the simulated data set. Subtraction of this confounding mathematical association was used to provide measurement of the true clinical association between recorded hypoglycemia (CBG < 4 mmol [< 72mg/dl]) and LOS. Results: A total of 196 962 admissions of 52 475 individuals with known diabetes were analyzed. 68 809 admissions of 29 551 individuals had >4 CBG measurements made and were included in analysis. After subtraction of the mathematical association of increased sample number, the clinical effect of recorded hypoglycemia is reduced—but persists—compared to previous studies. 1-2 days with recorded hypoglycemia has a relatively minor effect on LOS. LOS increases rapidly if there are ≥3 days with recorded hypoglycemia, with an increase of 0.75 days LOS per additional day with hypoglycemia. Conclusions: This technique increases accuracy of economic modeling of the impact of hypoglycemia on health care systems. This could assist study of the impact of hypoglycemia on other outcomes by factoring for bias of increased sample numbers.

The effect of hypoglycaemia during hospital admission on health‐related outcomes for people with diabetes: a systematic review and meta‐analysis

“…Despite these limitations, there are good reasons to be confident in these findings. They are supported by publications that were considered for inclusion but not eligible for the meta-analysis [36][37][38][39][40]. Furthermore, our findings support the statements from the American Diabetes Association [41] and the Joint British Diabetes Societies [4] guidelines who report that hypoglycaemia increases risks among people with diabetes admitted to hospital.…”

Electronic dashboard‐based remote glycemic management program reduces length of stay and readmission rate among hospitalized adults

“…Patients with diabetes are at a higher risk of prolonged LOS than those without diabetes 5,6,27,28 . Several studies have shown a relationship between poor glycemic control and an increased LOS [29][30][31] , especially among those with associated comorbidities, such as stroke, hospitalization for bone marrow transplantation and heart failure [32][33][34][35] . The association between hospital hyperglycemia and prolonged LOS was also observed among those without a previous history of diabetes (including undiagnosed diabetes and new-onset hyperglycemia during hospitalization) 35,36 .…”

Inpatient Hypoglycemia: The Challenge Remains

“…12 Hypoglycemia also increases length of stay, even after accounting for the number of glucose tests performed; a recent meta-analysis showed inpatients exposed to hypoglycemia had a 4.1-day longer hospital stay. 13,14 With the goal of providing safer care for inpatients with diabetes, the Centers for Medicare and Medicaid have designated SH as a never event and a safety measure of hospital harm for 2019.…”