Predictors of hypoglycemia in hospitalized patients with diabetes mellitus

Akirov, Amit; Amitai, Oren; Masri-Iraqi, Hiba; Diker-Cohen, Talia; Shochat, Tzipora; Eizenberg, Yoav; Shimon, Ilan

doi:10.1007/s11739-018-1787-0

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…A report of 792 patients from Israel revealed that the mean age of patients with hypoglycaemia was 73 ± 13 years and that 51% of men had hypoglycaemia. 6 These findings are similar to those in our study of 186 patients in that the mean age was 71 ± 15 years and 51.6% of men had hypoglycaemia.…”

Section: Discussionsupporting

confidence: 91%

Predisposing factors for hypoglycaemia in the emergency department

Liao

2019

J Int Med Res

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Objective Hypoglycaemia is a common complication of diabetes mellitus. Previous studies suggest that hypoglycaemic episodes may occur with other comorbidities, influencing the outcome of recovery. Recognising the predisposing factors for hypoglycaemic episodes in the emergency department is important. Therefore, we investigated the characteristics of and predisposing factors for hypoglycaemia in the emergency department. Methods Data from 186 patients were retrospectively collected from a medical centre in northern Taiwan. We divided the patients into the advanced-age group (132 patients) and the younger group (54 patients). Associated data collected for statistical analysis included vital signs on arrival, first measured blood glucose level, laboratory results, related comorbidities, length of hospital stay, and survival to discharge. Results Hypoglycaemia was more frequently observed in women in the advanced-age group than in the younger group. Tachycardia and elevated systolic blood pressure were less predominant in the advanced-age group than younger group. More patients in the advanced-age group had concurrent infection, and more patients in the younger group had liver dysfunction, elevated liver enzymes, liver cirrhosis, and concurrent stroke. Conclusions Closer attention should be paid to the possibility of infection in patients of advanced age. Liver disease and stroke need to be ruled out in younger patients.

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Section: Discussionsupporting

confidence: 91%

Predisposing factors for hypoglycaemia in the emergency department

Liao

2019

J Int Med Res

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“…When the blood glucose level drops, the sympathetic nervous system cannot be effectively excited, and asymptomatic hypoglycemia is prone to occur [ 30 ]. There are also studies that use the course of diabetes as a predictor of hypoglycemia in hospitalized patients [ 31 ]. In addition, elderly patients have decreased kidney and liver metabolic function and poor drug clearance and are hence prone to hypoglycemia during intensive insulin therapy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Hypoglycemia Risk Model for Intensive Insulin Therapy in Patients with Type 2 Diabetes

Lin

et al. 2020

Journal of Diabetes Research

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Aims. To develop a simple hypoglycemic prediction model to evaluate the risk of hypoglycemia during hospitalization in patients with type 2 diabetes treated with intensive insulin therapy. Methods. We performed a cross-sectional chart review study utilizing the electronic database of the Third Affiliated Hospital of Sun Yat-sen University, and included 257 patients with type 2 diabetes undergoing intensive insulin therapy in the Department of Endocrinology and Metabolism. Logistic regression analysis was used to derive the clinical prediction rule with hypoglycemia (blood glucose≤3.9 mmol/L) as the main result, and internal verification was performed. Results. In the derivation cohort, the incidence of hypoglycemia was 51%. The final model selected included three variables: fasting insulin, fasting blood glucose, and total treatment time. The area under the curve (AUC) of this model was 0.666 (95% CI: 0.594–0.738, P<0.001). Conclusions. The model’s hypoglycemia prediction and the actual occurrence are in good agreement. The variable data was easy to obtain and the evaluation method was simple, which could provide a reference for the prevention and treatment of hypoglycemia and screen patients with a high risk of hypoglycemia.

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“…7 Events of hypoglycemia during the course of a hospitalization, even in patients with T2DM, are common. 23 In a large cohort study by Akirov and colleagues, 24 15% of in-patient PWD experienced an event of hypoglycemia, with 7% of these involving blood glucose values of <54 mg/dL (3.0 mmol/L).…”

Section: Hypoglycemia Considerations In Patient Care Settingsmentioning

confidence: 99%

“…Hypoglycemia episodes occur more frequently in hospitalized patients with the following characteristics: older age, cognitive dysfunction, lower body mass index, long diabetes duration, history of cerebrovascular disease, history of chronic kidney disease, A1C >9.0% (75 mmol/mol), and insulin treatment. 23,24 Hypoglycemia risk in hospitalized PWD increases by 11% with each decade of life. 24 In long-term care facilities, 25% to 35% of residents are admitted with a diagnosis of diabetes.…”

Section: Hypoglycemia Considerations In Patient Care Settingsmentioning

confidence: 99%

“…23,24 Hypoglycemia risk in hospitalized PWD increases by 11% with each decade of life. 24 In long-term care facilities, 25% to 35% of residents are admitted with a diagnosis of diabetes. 25,26 Hypoglycemia events occur in more than 40% of longterm care residents with diabetes, many of whom are treated with insulin; these individuals experience greater emergency department utilization, more frequent hospitalizations, and higher rates of mortality than peers who have never experienced a hypoglycemia event.…”

Section: Hypoglycemia Considerations In Patient Care Settingsmentioning

confidence: 99%

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Diabetes Education Impact on Hypoglycemia Outcomes: A Systematic Review of Evidence and Gaps in the Literature

et al. 2019

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Purpose The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes. Methods The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included. Results Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature. Conclusions Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.

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Predictors of hypoglycemia in hospitalized patients with diabetes mellitus

Cited by 14 publications

References 23 publications

Predisposing factors for hypoglycaemia in the emergency department

Predisposing factors for hypoglycaemia in the emergency department

Development and Validation of a Hypoglycemia Risk Model for Intensive Insulin Therapy in Patients with Type 2 Diabetes

Diabetes Education Impact on Hypoglycemia Outcomes: A Systematic Review of Evidence and Gaps in the Literature

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