Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

Abstract

ImportanceThe frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.ObjectiveWe determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.Research design and methodsProspective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.ResultsAmong 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4–14) vs 7 days (IQR 5–15), p=0.92)) between groups.ConclusionsAsymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.

Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients

“…In addition, this study was unable to assess symptoms of hypoglycemia. In a previous study of 250 insulin requiring hospitalized patients, 45% of patients who had a glucose < 3.8 mmol/L were asymptomatic [27]. Despite these limitations, this is the largest study of BB use and hypoglycemia risk in hospitalized patients to date.…”

“…A recent large inpatient analysis identified risk factors for hypoglycemia, but did not report BB use [26]. Cardona and colleagues [27] did not identify a difference in risk according to BB use, but the study was much smaller (N = 250). In the ambulatory setting, there is also low quality evidence assessing the risk of hypoglycemia with BB use [12].…”

Inpatient Hypoglycemia: The Challenge Remains

“…While the majority of patients report symptoms with hypoglycemia, up to 44% of episodes can be asymptomatic, especially in the elderly and those with lower admission A1c levels. 15 The frequency and accuracy of BG monitoring is extremely important; harm can occur when insulin is titrated based on an incorrect value. 16 The recommended monitoring frequency is detailed in Table 1.…”

Hypoglycaemia and its management in primary care setting

“…Hypoglycaemia among hospitalized patients is common, occurring in up to one‐third of patients treated with insulin in medical and surgical wards. Hypoglycaemia in the hospital setting has been associated with increased morbidity and mortality 135 …”

“…The study results supported the recommendations on the need for frequent blood glucose measurements in those treated with insulin in general wards. Health care providers should be aware of the problem of hypoglycaemia in the hospital setting 135 …”