Risk factors and outcomes of severe hypoglycaemia requiring hospital admission: a retrospective study

Abstract

This is a retrospective study intended to determine the prevalence of severe hypoglycaemia requiring admission to Mater Dei Hospital from January to December 2018. We identified risk factors associated with hospital admission and conducted a survival analysis of the cohort.All patients admitted with diabetes and hypoglycaemia were identified by means of hospital admission database, clinical notes, discharge summaries and iSOFT clinical manager. A Cox regression model and a multivariate analysis were utilised to study survival analysis at one year after admission in relation to management strategies, comorbidity and length of hospital stay.A total of 167 episodes (0.77%) of hypoglycaemia admissions satisfying inclusion criteria were identified out of 21,589 medical admissions. Type 2 diabetes (T2DM) was present in 154 patients (92.2%), mean age was 71.5 years (SD 15.5) and mean length of stay was 4.4 days (SD 5.3). A survival analysis showed a negative association with a higher Charlson Comorbidity Index (CCI) score (95% CI 1.132-1.516, p<0.05), Parkinson's disease (95% CI 0.078-0.670, p<0.05) and residing in care homes (95% CI 0.274-0.982, p<0.05). Length of stay was related to a poor CCI score (95% CI 0.251-0.967), peripheral vascular disease (95% CI -4.658-0.764), and malignancy (95% CI -5.438-0.205). There seemed to be no correlation between different diabetes treatment regimens and length of hospital stay or survival.These findings show a strong link between hypoglycaemia, decreased survival and increased frailty in elderly patients with type 2 diabetes. This study highlights a need for better education and less stringent glycaemic targets for vulnerable patients.

Medication-Related Hospital Admissions and Emergency Department Visits in Older People with Diabetes: A Systematic Review

“…Ultimately, 35 studies met the pre-defined inclusion criteria , of which 8 studies were identified through citation analysis. Studies were published between 2005 and 2023 and conducted mainly in the United States (US) (n = 7) [24,26,36,42,47,49,52], Italy (n = 6) [23,29,31,33,41,53], Korea (n = 4) [30,38,48,55], Denmark (n = 2) [45,46], Germany (n = 2) [25,43], Greece (n = 2) [22,28], Japan (n = 2) [37,56], Portugal (n = 2) [35,44], Taiwan (n = 2) [32,50], Malta (n = 1) [51], Pakistan (n = 1) [27], France (n = 1) [54], Spain (n = 1) [39], Thailand (n = 1) [40], and the United Kingdom (UK) (n = 1) [34].…”

“…In terms of study orientation, the majority were retrospective studies (n = 29), with study designs varying from analytical cross-sectional (n = 16) [22,24,[29][30][31]33,35,40,43,48,[50][51][52][53]55,56], cohort (n = 10) [25,26,32,34,36,41,42,46,47,49], prevalence (descriptive crosssectional) (n = 6) [23,27,37,39,44,54], to case-control (n = 3) [28,38,45]. Most studies (60%) were rated as being high quality (Tables S4-S7) [23,24,30,32,[35][36][37][38][39][40][41][43][44]…”

“…The included studies used objective criteria obtained from medical records (n = 18) [22,23,[27][28][29]31,33,[35][36][37]39,44,47,[49][50][51]53,54,56], administrative databases (n = 12) [24,26,30,32,38,42,43,45,46,48,55], patients' registries (n = 4) [25,34,40,52] or a combination of sources (n = 1) [41] to identify patients, their characteristics, and the study outcomes. The outcomes observed, hospital admissions and/or ED visits, were predominantly recorded using the International Classification of Diseases 10th Revision (ICD-10) (n = 14) [30,34,36,42,43,[45][46][47][48][49]52,[54][55]…”

“…Compared to self-report, this source of data could minimise the bias of detecting hypoglycaemia that sometimes can be misinterpreted in the older adult due to their overlapping features with geriatric syndromes [2]. However, in many of the studies [24,27,30,33,36,38,42,43,48,49,51], there was no differentiation made between the outcomes of ED visits and hospitalisations. Consequently, for these studies, it remains unclear whether the ED visits ultimately led to hospitalisation or not.…”