Inpatient Hypoglycemia: The Challenge Remains

Abstract

Hypoglycemia in inpatients with diabetes remains the most common complication of diabetes therapies. Hypoglycemia is independently associated with increased morbidity and mortality, increased length of stay, increased readmission rate, and increased cost. This review describes the importance of reporting and addressing inpatient hypoglycemia; it further summarizes eight strategies that aid clinicians in the prevention of inpatient hypoglycemia: auditing the electronic medical record, formulary restrictions and dose-limiting strategies, hyperkalemia order sets, electronic glucose management systems, prediction tools, diabetes self-management, remote surveillance, and noninsulin medications.

Development and Validation of a Machine Learning Model to Predict Near-Term Risk of Iatrogenic Hypoglycemia in Hospitalized Patients

“…Inpatient hypoglycemia is a prevalent and often preventable adverse event associated with increased morbidity and mortality, length of stay, readmissions, and health care expenditures. 1 , 2 , 3 , 4 , 5 , 6 Considering that most patients with diabetes are hospitalized for reasons other than glucose management, 7 , 8 situational unawareness of the near-term risk of iatrogenic hypoglycemia may result from competing medical priorities, lack of sufficient training in glycemic pattern recognition, 9 , 10 , 11 or other system factors. 12 Studies 13 , 14 , 15 have demonstrated practitioner inertia in adjusting glucose-lowering medications before hypoglycemic events or in response to antecedent hypoglycemia.…”

“… 1 Changes in dextrose-containing fluids, tapering corticosteroid doses, disruption in parenteral nutrition or continuous tube feedings, mismatched timing of point-of-care blood glucose (BG) testing with insulin delivery and meal consumption, correctional scale overuse, and insulin stacking are just a few examples of the various factors that can influence the risk of iatrogenic hypoglycemia. 1 …”

Development and Validation of a Prediction Model of Perioperative Hypoglycemia Risk in Patients with Type 2 Diabetes Undergoing Elective Surgery

“…For instance, when blood glucose decreases to 70mg/dL (3.9mmol/L), cognitive dysfunction may occur; when blood glucose decrease to 54mg/dl (3.0mmol/L) and sustains for a long time, it may cause brain death [11] . Perioperative hypoglycemia, especially repeated and severe hypoglycemia, may negatively affect the health outcomes of the patients, leading to increased morbidity and mortality, length of stay, readmissions, and health care expenditures [9][10] . In addition, it may also bring about a huge socio-economic burden to the family and society as a whole [9][10] .…”

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

“…5 Hypoglycemia has been minimized through risk factor reduction with the use of clinical strategies including standardized reporting, order sets, and hypoglycemia protocols in addition to implementation of technological tools such as electronic medical records, continuous subcutaneous insulin infusion pumps, and continuous glucose monitoring technology with predictive scores and remote surveillance capability. 6 The cost of diabetes is currently accounting for almost $250 billion (one in four healthcare dollars spent in the United States). 7 It is estimated that hypoglycemia may add 31% to the overall cost for an inpatient stay, with the average cost of $4312 per admission.…”