Temporal and geographic patterns of hypoglycemia among hospitalized patients with diabetes mellitus

Abstract

Background: Hypoglycemia is often cited as a barrier to achieving inpatient glycemic targets. We sought to characterize hypoglycemic events in our institution by work-shift cycle and by specific treatment area.

Methods: Capillary (bedside) and blood (laboratory) glucose values of <70 mg/dl for patients with either a known diagnosis of diabetes or with evidence of hyperglycemia were abstracted from our laboratory database for hospitalizations between October 1, 2007, and February 3, 2008. Hypoglycemic events were analyzed by 12 h nursing work-shift cycles (day shift, 07:00 to 18:59; night shift, 19:00 to 06:59) and by the six medical, surgical, and intensive care areas in the hospital (designated areas 1 to 6).

Results: We identified 206 individual patients with either diabetes or hyperglycemia (mean age, 67 years; 56% men; 83% white) who had 423 hypoglycemic events. There were 78% more hypoglycemic events during the night shift (n = 271 events in 128 individual patients) than during the day shift (n = 152 events in 96 individual patients). Most of the night-shift hypoglycemic measurements were detected between 04:00 and 04:59 or 06:00 and 06:59. The mean hypoglycemic level was comparable between shifts (p = .79) and across the six inpatient areas. The number of hypoglycemic events per person increased with lengths of hospital stay >5 days. The prevalence of hypoglycemia varied across patient care areas within the hospital, with most (28%) detected in one area of the hospital.

Conclusion: There are temporal and geographic patterns in the occurrence of hypoglycemia among patients with diabetes or hyperglycemia in our hospital. Further study should focus on the reasons underlying these variations so that specific interventions can address the risk of hypoglycemia during peak times and places.

(c) 2009 Diabetes Technology Society.

Figures

Figure 1.

More hypoglycemic events (defined as

Figure 2.

In a 24 h period, most hypoglycemic events in hospital patients occurred (A) between 04:00 and 04:59 or between 06:00 and 06:59; other peaks occurred between 11:00 and 11:59, 16:00 and 16:59, and 21:00 and 21:59 hours. (B) bedside glucose data contributed to the peaks occurring between 06:00 and 07:00, 11:00 and 11:59, 16:00 and 16:59, and 21:00 and 21:59 hours. Whereas, (C) laboratory glucose data contributed to the peak that occurred between 04:00 and 05:00 hours.

Figure 3.

(A) More hypoglycemic events were seen with longer lengths of stay. (B) Prevalence of hypoglycemia by inpatient care area.