Hypoglycemia in hospitalized patients treated with antihyperglycemic agents

Abstract

OBJECTIVE:To determine the incidence and manifestations of hypoglycemia in hospitalized patients receiving antihyperglycemic therapy. RESEARCH DESIGN AND METHODS:The study was a 3-month prospective review of consecutive medical records of all adult, nonpregnant hospitalized patients at a 675-bed university hospital who experienced at least 1 blood glucose (BG) Յ 60 mg/dL within 48 hours of receiving an antihyperglycemic agent. MEASUREMENTS AND RESULTS:Of 2174 patients receiving antihyperglycemic agents, 206 (9.5%) experienced 484 hypoglycemic episodes. Of these episodes, 29% occurred in patients with type 1 diabetes, 23% in the ICU, and 72% in patients receiving only insulin for hyperglycemia. More than 1 episode was experienced by 44% of the 206 patients. Furthermore, 4% (20 of 484) of the hypoglycemic episodes were associated with a hypoglycemia-related adverse event, defined as symptoms, signs, or injury. The mean BG of these episodes was 43.0 mg/dL, significantly lower than the mean BG of 50.9 mg/dL for the 464 episodes without adverse events (P ϭ .01). One-third of the adverse events occurred with a BG between 50 and 60 mg/dL; half the adverse events, 10 episodes or 2% of all hypoglycemic episodes, were serious, involving seizures or an unresponsive patient. A decrease in enteral intake accounted for 40% of the episodes; none was attributed to medication error.Less than half the hypoglycemic patients had documented euglycemia within 2 hours. Sulfonylurea agents were associated with higher rates of hypoglycemia than were other oral agents. CONCLUSIONS:

The clinical impact of hypoglycemia in hospitalized patients

“…This phenomenon is well documented on the inpatient treatment. One study reported that 40% of hospitalized patients had recurrent episodes of hypoglycemia, 22 while in another study severe hypoglycemic episodes were preceded by mild hypoglycemia in more than 60% of cases. 23 Another factor favoring a dysregulation of the counter is the [page 12] [Italian Journal of Medicine 2015; 9:549] presence of autonomic neuropathy.…”

Blood glucose management in the patient undergoing cardiac surgery: A review

“…Intraoperative blood glucose concentrations should be measured no less frequently than hourly. Patients with abnormal kidney function should be identified preoperatively since there is a greater incidence of perioperative hypoglycemia in these patients [43,44] .…”

MECHANISMS IN ENDOCRINOLOGY: Seizures and type 1 diabetes mellitus: current state of knowledge

“…Hypoglycemia is a common problem in diabetic patients treated with insulin and can induce various neurological disturbances, such as confusion, motor restlessness, hypotonia, and epileptic seizures, which represent a relatively common acute symptom (41,70). The association between hypoglycemia and epilepsy or seizures has not yet been fully understood.…”