Hypoglycemic episodes in hospitalized people with diabetes in Portugal: the HIPOS-WARD study

Abstract

Background We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. Methods In this cross-sectional, multicentered study, the observational data was collected by physicians from patient’s hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. Results There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). Conclusions Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.

Epidemiological, Social and Economic Burden of Severe Hypoglycaemia in Patients with Diabetes Mellitus in Portugal: A Structured Literature Review

“…Characteristics of included studies reporting on the epidemiological, social and economic burden associated with SH in patients with DM in Portugal are presented in Table 1 , where it is specified if the study was conducted in a healthcare setting integrated in the NHS. Almost all records (11 out of 12) were published between 2016 and 2021 [ 11 , 22 – 31 ]. Of the 12 studies included in this review, only 2 [ 26 , 27 ] investigated SHEs in patients with T1DM.…”

“…Of the 12 studies included in this review, only 2 [ 26 , 27 ] investigated SHEs in patients with T1DM. In the remaining studies, three focused on T2DM [ 24 , 25 ] and seven reported data on both T1DM and T2DM [ 11 , 23 , 25 , 28 , 30 – 32 ].…”

“…Each study was conducted in a healthcare setting, although the type of setting varied between studies; emergency hospital setting was the most common [ 24 , 25 , 28 , 30 ], followed by a hospital ward [ 11 , 23 , 29 ], emergency and resuscitation medical vehicle unit [ 31 , 32 ], hospital-based diabetes clinic [ 26 , 27 ] and community pharmacy [ 25 ]. Five studies were based on data collected across multiple centres [ 11 , 23 – 25 ], with the number of centres ranging from EDs within 7 hospitals [ 24 ] to 233 community pharmacies [ 25 ]. Of all included studies, ten adopted an observational study design [ 11 , 25 – 27 , 29 – 33 ].…”

“…Five studies were based on data collected across multiple centres [ 11 , 23 – 25 ], with the number of centres ranging from EDs within 7 hospitals [ 24 ] to 233 community pharmacies [ 25 ]. Of all included studies, ten adopted an observational study design [ 11 , 25 – 27 , 29 – 33 ]. Azevedo et al [ 27 ] and Pereira et al [ 28 ] used a longitudinal approach to examine trends in SHEs over time.…”

“…Portugal has tried to contrast the incidence of hypoglycaemia by increasing the use of DPP-4i, sodium-glucose cotransporte-2 inhibitors (SGLT-2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs), all associated with a lower risk of hypoglycaemia, and by decreasing the use of sulphonylurea. However, it is unclear whether this approach has influenced the number of hospital admissions due to hypoglycaemia [ 11 ].…”