Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

Abstract

OBJECTIVEHypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. It is not known whether the same risks exist for diabetic patients who are less severely ill. In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward.RESEARCH DESIGN AND METHODSThis retrospective cohort study analyzed 4,368 admissions of 2,582 patients with diabetes hospitalized in the general ward of a teaching hospital between January 2003 and August 2004. The associations between the number and severity of hypoglycemic (≤50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated.RESULTSHypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). LOS increased by 2.5 days for each day with hypoglycemia (P < 0.0001).CONCLUSIONSHypoglycemia is common in diabetic patients hospitalized in the general ward. Patients with hypoglycemia have increased LOS and higher mortality both during and after admission. Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population.

Management of hospitalized type 2 diabetes mellitus patients

“…[20,21] Hypoglycemia in hospitalized T2DM patients has been associated with poor outcomes and 2.8 days longer hospital stay. [22] However, other studies suggest that the increased mortality rate associated with hypoglycemia is only with spontaneous hypoglycemia rather than drug-associated hypoglycemia. [23] The causes of hypoglycemia in hospitalized T2DM patients include continued hypoglycemic therapy, such as sulfonylureas, when caloric intake is stopped or reduced, use of standard sliding-scale insulin inadequately, [24] errors in insulin dosing, and implementation of intensive insulin therapy in critically ill patients.…”

“…[26] Inpatient mortality was significantly higher for patients with at least one hypoglycemic (< 50 mg/dL) episode. [22] We can prevent or reduce hypoglycemic events in hospitalized patients by: [27] -Recognizing precipitating factors. …”

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna

“…Además de lo mencionado, no logramos identificar en el presente estudio otros factores asociados a hipoglicemia. Turchin et al 10 , en un estudio de cohorte retrospectivo reporta una frecuencia de 7,7%, definiendo hipoglicemia bajo 50 mg/dl, y de hiperglicemia superior a 300 mg/dl en 29,1%. Es de notar que, al igual que nuestro estudio, no encuentra asociación de la hipoglicemia con complicaciones crónicas, velocidad de filtración glomerular, función hepática ni edad .…”

“…Por lo mismo, no podemos concluir que la presencia de hipoglicemias sea o no un factor de riesgo independiente para mortalidad. Algunos autores consideran a la hipoglicemia intrahospitalaria un marcador de gravedad y de mala evolución clínica 9,10 .…”

“…En los pacientes diabéticos se invierte el doble de los recursos que en los no diabéticos en cuanto a farmacia, insumos y recursos de personal involucrados 7 . Durante la hospitalización, la hiper e hipoglicemia deterioran la evolución y el pronóstico de pacientes diabéti-cos [8][9][10] ; más aun, la hiperglicemia de estrés en individuos sin antecedentes de diabetes en unidades de pacientes críticos es claramente deletérea 11 . El control glicémico estricto ha demostrado mejorar la sobrevida y disminuir la morbimortalidad de pacientes diabéticos y no diabéticos en tales unidades [12][13][14][15] .…”