Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

Abstract

Background: Previous studies have shown low adherence to the recommendation to repeat point-of-care glucose (POCG) within 15 minutes following the treatment of inpatient hypoglycemia. We sought to evaluate whether patient and clinical factors may predict time-to-repeat (TTR) POCG following hypoglycemic events in hospitalized adult patients. Methods: This was a retrospective cross-sectional analysis of 22 226 index hypoglycemic (≤70 mg/dL) readings (of 993 395 total POCG samples) from 6226 hospital admissions within the Johns Hopkins Health System over three years. Time-to-repeat was defined as the difference in time (minutes) between the index POCG and the next POCG sample. Multivariable logistic regression was used to evaluate the association of TTR with clinical, patient, and hospital factors. Results: The median (IQR) TTR was 49 (25-119) minutes, and 14.1% of index POCGs had a TTR ≤15. Severity of hypoglycemia, intensive care unit (ICU), intermediate care (IMC) and pediatrics admissions, and dextrose or glucagon administration were associated with higher adjusted odds of TTR ≤15 minutes. Admission to community hospitals, procedural units, surgery, and labor and delivery was associated with lower adjusted odds of TTR ≤15 minutes. Age, sex, insulin on board, secretagogue use, diabetes type, nutritional status, previous POCG value, and glycemic variability were not significantly associated. Conclusion: There is low adherence to the recommendation to repeat a POCG within 15 minutes following the treatment of inpatient hypoglycemia, which may be mediated by both patient and hospital factors. Further studies are needed to understand the mediators and implications of this practice variability.

Evaluation of the Efficacy of a Hypoglycemia Protocol to Treat Severe Hypoglycemia

“…13 This is commonly known as the "15-15 rule" and is recommended in many hospital hypoglycemia policies. 14 Since 2014, our large academic health system in the southeastern United States has implemented a nurseinitiated Adult Inpatient Hypoglycemia Protocol (HP) based on ADA guidelines with input from members of the hospital's Glycemic Safety Committee (Figure 1). The last HP revision occurred in 2018 based on the revised ADA guidelines that were published the same year.…”

“…Once the patient is no longer hypoglycemic with BG of 70 mg/dL or greater, the patient should consume a snack to prevent recurrent hypoglycemia 13 . This is commonly known as the “15-15 rule” and is recommended in many hospital hypoglycemia policies 14 …”