How Low Can You Go? Reducing Rates of Hypoglycemia in the Non-critical Care Hospital Setting

Abstract

Strategies to reduce hypoglycemia rates should focus on the most common causes of iatrogenic hypoglycemia. Creating a standardized insulin order set with built-in clinical decision support can help reduce rates of hypoglycemia. Coordination of blood glucose monitoring, meal tray delivery, and insulin administration is an important and challenging task. Protocols and processes should be in place to deal with interruptions in nutrition to minimize risk of hypoglycemia. A glucose management page that has all the pertinent information summarized in one page allows for active surveillance and quick identification of patients who may be at risk of hypoglycemia. Finally, education of prescribers, nurses, food and nutrition services, and patients is important so that every member of the healthcare team can work together to prevent hypoglycemia. By implementing strategies to reduce hypoglycemia, we hope to lower rates of adverse events and improve quality of care while also reducing hospital costs. Future research should focus on the impact of an overall reduction in hypoglycemia to determine whether the expected benefits are achieved.

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

“…Previous studies have reported that increasing age is an independent risk factor for the development of hypoglycemia in insulin-treated patients with type 2 diabetes 4. It has also been shown that elderly patients frequently fail to communicate symptoms of hypoglycemia to hospital staff32 and develop hypoglycemic symptoms at a significantly lower glucose concentration compared with younger patients 33. These factors often lead to more prolonged and more severe hypoglycemia in the elderly.…”

Development and validation of a prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults

“…Hypoglycemia is a common occurrence in hospitalized patients and is linked to multiple adverse clinical outcomes and mortality. 1 Acute hypoglycemia can provoke cardiac ischemia and arrhythmias, as well as neurologic harm ranging in severity from altered cognition or irritability to focal neurologic deficits, loss of consciousness, stroke, seizures, and coma. 2 Besides these potentially life-threatening complications, hypoglycemia can be a source of patient dissatisfaction and worry.…”

“… 2 Besides these potentially life-threatening complications, hypoglycemia can be a source of patient dissatisfaction and worry. 1 Approximately half of hypoglycemic events in the hospital are iatrogenic, usually resulting from insulin treatment. 3 In observational studies of hospitalized patients, both spontaneous and iatrogenic hypoglycemia are associated with increased mortality.…”

“… 3 In observational studies of hospitalized patients, both spontaneous and iatrogenic hypoglycemia are associated with increased mortality. 3–6 Considering that 20%–40% of hospitalized patients require glucose-lowering medications, 1 prevention of iatrogenic hypoglycemia is a significant patient safety issue and a major challenge to our healthcare system.…”

GlucoTab – Diabetesmanagement im Krankenhaus

“…Im Verhältnis zur generellen Diabetesprävalenz (7 %) belegen Patienten mit Diabetes mellitus -abhängig von Region und Fokus des Krankenhauses -überproportional viele Akutbetten in Krankenhäusern (8-40 %), wobei nur ein Bruchteil davon primär wegen der Diabeteserkrankung stationär aufgenommen wurde (8 %) [15].…”