Iatrogenic Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention

Maynard, Gregory; Huynh, Maggie Patricia; Renvall, Marian

doi:10.2337/diaspect.21.4.241

Cited by 36 publications

(29 citation statements)

References 23 publications

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“…These findings were consistent with our prior examination of hypoglycemia cases. 13 Severe hyperglycemia (glucose !300mg/dL) occurred in 5 (15 %) patients following the protocol vs. 19 (49%) patients not following protocol (P ¼ 0.002.) Patients with diabetes following the protocol received significantly more insulin in the first 24 hours (mean of 65 units vs. 27 units, P 0.001) and 24 to 48 hours after transition (mean of 61 units vs. 28 units, p 0.001) than those not following protocol.…”

Section: Patients With Diabetesmentioning

confidence: 99%

Maintaining glycemic control when transitioning from infusion insulin: A protocol‐driven, multidisciplinary approach

Ramos

Childers

Maynard

et al. 2010

Journal of Hospital Medicine

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Background: An observational pilot study of 41 medical and surgical intensive care patients on infusion insulin at our own institution found that glycemic control rapidly deteriorated within 48 hours of stopping infusion insulin. This prompted the design and testing of a transition protocol. Methods: The transition protocol identified appropriate patients for subcutaneous (SC) insulin along with the insulin dose and schedule. A pharmacist‐hospitalist improvement team offered protocol guidance but adherence was left to the discretion of the provider. The primary endpoints were mean blood glucose the first and second day after stopping the insulin infusion and the number of patients with hypoglycemia (41‐70 mg/dL) and severe hypoglycemia (<40 mg/dL) during the 48‐hour transition. Secondary endpoints include severe hyperglycemia (>300 mg/dL), length of stay (LOS), re‐initiation of the infusion insulin, day‐weighted glucose mean 12 days following transition for patients with diabetes, and identification of a new diagnosis of diabetes. Results: Patients with diabetes transitioned by protocol (n = 33) had better glycemic control than those (n = 39) transitioned without the protocol (Day 1 population glucose mean of 168 mg/dL vs. 211 mg/dL [P<0.001], Day 2 means of 176 mg/dL vs 218 mg/dL [P<0.001]). Severe hypoglycemia occurred once in each group. There were 14 patients newly diagnosed with diabetes based on an A1c ≥6%. Patients with stress hyperglycemia maintained good glycemic control with correctional insulin only. Conclusion: Protocol adherence improved glycemic control, reduced unnecessary use of insulin, and identified patients with previously undiagnosed diabetes, without any increase in hypoglycemia. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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Section: Patients With Diabetesmentioning

confidence: 99%

Maintaining glycemic control when transitioning from infusion insulin: A protocol‐driven, multidisciplinary approach

Ramos

Childers

Maynard

et al. 2010

Journal of Hospital Medicine

Self Cite

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show abstract

“…4 In addition, health care providers' recognition and management of hypoglycemia are sometimes lacking, especially in patients receiving insulin. 5,6 This review article discusses the causes and consequences of hypoglycemia, and the potential risk of hypoglycemia associated with existing and emerging diabetes drug classes in patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemic Potential of Current and Emerging Pharmacotherapies in Type 2 Diabetes Mellitus

Brunton¹

2012

Postgraduate Medicine

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Intensive glycemic control can reduce the risk of microvascular complications in patients with type 2 diabetes mellitus (T2DM). However, hypoglycemia induced by diabetes medications is recognized as a major limiting factor in the attainment of glycemic goals. Mild hypoglycemia is relatively common in patients with T2DM, and the prevalence of severe hypoglycemia increases with insulin treatment and can approach the prevalence seen in patients with type 1 diabetes. Mild hypoglycemia and the fear of hypoglycemia can have a substantial impact on the physical, mental, social, and economic well-being of patients with T2DM. Severe hypoglycemia is more serious and may be associated with an increased risk of dementia, cardiovascular events, and death. Insulin and insulin secretagogue therapies (eg, sulfonylureas and meglitinides) are the major causes of hypoglycemia in patients with T2DM. Other diabetes drugs, such as metformin, when used as monotherapy, have a low risk of hypoglycemia. Emerging experimental therapies, such as activators of the free fatty acid receptor 1, G protein-coupled receptor 119 agonists, glucokinase activators, inhibitors of 11β-hydroxysteroid dehydrogenase type 1, and sodium-glucose co-transporter 2 inhibitors, some of which have mechanisms of action consistent with a potential low risk of hypoglycemia, may help patients with T2DM achieve improved glycemic control.

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“…Among 1718 adult patients admitted at academic medical centers and having hyperglycemia or receiving insulin therapy, hypoglycemia occurred on 2.8% of all hospital days (Boord et al, 2009). Predisposing factors and adverse outcomes associated with hypoglycemia have been examined in observational studies and in clinical trials studying the effect of glycemic control upon nonglycemic outcomes (Bagshaw et al, 2009;Fischer et al, 1986;Finfer et al, 2009;Kagansky et al, 2003;Krinsley et al, 2007;Maynard et al, 2008;Smith et al, 2005;Stagnaro-Green et al, 1995;Turchin et al, 2009;Van den Berghe et al, 2006;Varghese et al, 2007;Vriesendorp et al, 2006;Wexler et al, 2007). Mortality of patients having myocardial infarction is higher at the lowest as well as the highest ranges glucose, such that the relationship between mortality and glucose is described by a J-shaped curve (Kosiborod et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

Braithwaite¹,

Clark²,

Dacenko-Grawe³

et al. 2011

Diabetes - Damages and Treatments

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Iatrogenic Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention

Cited by 36 publications

References 23 publications

Maintaining glycemic control when transitioning from infusion insulin: A protocol‐driven, multidisciplinary approach

Maintaining glycemic control when transitioning from infusion insulin: A protocol‐driven, multidisciplinary approach

Hypoglycemic Potential of Current and Emerging Pharmacotherapies in Type 2 Diabetes Mellitus

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

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