Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward

Alexander Turchin, Michael E Matheny, Maria Shubina, James V Scanlon, Bonnie Greenwood, Merri L Pendergrass, Alexander Turchin, Michael E Matheny, Maria Shubina, James V Scanlon, Bonnie Greenwood, Merri L Pendergrass

Abstract

Objective: Hypoglycemia 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 methods: This 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 (<or=50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated.

Results: Hypoglycemia 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).

Conclusions: Hypoglycemia 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.

Figures

Figure 1
Figure 1
Frequency of hypoglycemia and 1-year mortality. Bars indicate 95% CI. The number of admissions in each category is given in parentheses.
Figure 2
Figure 2
Lowest blood glucose and inpatient mortality. The lowest blood glucose level recorded during the hospital stay was plotted against the fraction of patients who died during the admission for 338 patients who had at least one hypoglycemic episode documented in the hospital. Bars indicate 95% CI. The number of admissions in each category is given in parentheses.
Figure 3
Figure 3
Frequency of hypoglycemia and length of hospital stay. Bars indicate SEM. The number of admissions in each category is given in parentheses.

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