Diurnal temporal patterns of hypoglycaemia in hospitalized people with diabetes may reveal potentially correctable factors

Kerry, C.; Mitchell, Sandy; Sharma, S C; Scott, A.; Rayman, Gerry

doi:10.1111/dme.12256

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…The current study was designed to determine whether similar or other temporal patterns of hypoglycaemia exist in other NHS hospitals and, if so, to consider the possible reasons for any observed differences and potential preventative strategies. Additionally, in the previous study, there appeared to be more hypoglycaemic readings in those on sulfonylurea therapy than anticipated, but that study was not specifically designed to examine this 11. As a result of this anecdotal observation and in view of the ADA's abandonment of sulfonylurea therapy in the inpatient setting, the current study was also designed to compare hypoglycaemic rates and patterns in sulfonylurea and insulin-treated inpatients.…”

Section: Introductionmentioning

confidence: 91%

“…In a recent study of inpatient hypoglycaemia in one NHS hospital, we found that more than two-thirds of all hypoglycaemic readings occurred between 21:00 and 8:59 11. The current study was designed to determine whether similar or other temporal patterns of hypoglycaemia exist in other NHS hospitals and, if so, to consider the possible reasons for any observed differences and potential preventative strategies.…”

Section: Introductionmentioning

confidence: 96%

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Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

2014

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ObjectivesTo determine whether temporal patterns of hypoglycaemia exist in inpatients with diabetes ‘at risk’ of hypoglycaemia (those on insulin and/or sulfonylureas), and if so whether patterns differ between hospitals and between these treatments.SettingRetrospective multicentre audit of inpatients with diabetes involving 11 acute UK National Health Service (NHS) trusts.ParticipantsCapillary blood glucose readings of 3.9 mmol/L or less (hypoglycaemia) for all adult (≥18 years) inpatients with diabetes ‘at risk’ of hypoglycaemia were extracted from the Abbott PrecisionWeb Point-of-Care Data Management System over a 4-week period. Overall, 2521 readings of 3.9 mmol/L or less (hypoglycaemia) occurring in 866 participants between 1 June 2013 and 29 June 2013 were analysed.ResultsThe majority (65%) occurred between 21:00 and 08:59, a pattern common to all Trusts. This was more frequent in sulfonylurea-treated than insulin-treated participants (75.3% vs 59.3%, p=0.0001). Furthermore, hypoglycaemic readings were more frequent between 5:00 and 7:59 in sulfonylurea-treated than insulin-treated participants (46.7% vs 22.7% of readings for respective treatments, p=0.0001). Sulfonylureas accounted for 31.8% of all hypoglycaemic readings. As a group, sulfonylurea-treated participants were older (median age 78 vs 73 years, p=0.0001) and had lower glycated haemoglobin (median 56 (7.3%) vs 69 mmol/mol (8.5%), p=0.0001). Hypoglycaemic readings per participant were as frequent for sulfonylurea-treated participants as for insulin-treated participants (median=2 for both) as were the proportions in each group with ≥5 hypoglycaemic readings (17.3% vs 17.7%).ConclusionsIn all Trusts, hypoglycaemic readings were more frequent between 21:00 and 08:59 in ‘at risk’ inpatients with diabetes, with a greater frequency in the early morning period (5:00–7:59) in sulfonylurea-treated inpatients. This may have implications for the continuing use of sulfonylureas in the inpatient setting.

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Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 96%

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

2014

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“…[1][2][3][4] In the UK National Diabetes Inpatient Audit, hypoglycaemia occurred in 23.4% of inpatients with diabetes and 2.2% of these patients required parenteral glucose or glucagon. 5 The frequency and severity of hypoglycaemia has been associated with an increase in pre-and post-discharge mortality and length of admission.…”

Section: Introductionmentioning

confidence: 99%

Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

et al. 2015

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Aims: Hypoglycaemia confers excess morbidity and mortality. UK guidelines recommend capillary blood glucose (CBG) measurement is repeated 15 minutes following identification and treatment of CBG <4 mmol/L. We assessed adherence to this guidance, influence of initial CBG on time to repeat (TTR), and the impact of a quality improvement intervention on TTR. Conclusions: TTR is a marker of treatment quality in hypoglycaemia and is suboptimal. TTR reduces with worsening initial degree of hypoglycaemia. We have shown that a quality improvement package can produce sustained reduction of TTR. Br J Diabetes Vasc Dis 2015;15:24-26

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“…The group has already published their work in parts in international journals to share best practice. 12,13 The judges particularly liked the fact that the innovation was comprehensive, multicentred, impactful and was shared well nationally through presentations and publications in reputed journals.…”

Section: Resultsmentioning

confidence: 99%

The best hypoglycaemia avoidance initiative in the UK

et al. 2017

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Diurnal temporal patterns of hypoglycaemia in hospitalized people with diabetes may reveal potentially correctable factors

Abstract: Hypoglycaemia occurs more frequently between 21.00 and 09.00 h in hospitalized patients receiving treatments that can cause hypoglycaemia. This may be related to insufficient carbohydrate intake during this period, and is potentially preventable by changes in catering practice.

Cited by 19 publications

References 28 publications

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

Temporal patterns of hypoglycaemia and burden of sulfonylurea-related hypoglycaemia in UK hospitals: a retrospective multicentre audit of hospitalised patients with diabetes

Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

The best hypoglycaemia avoidance initiative in the UK

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