The impact of hypoglycaemia on patients admitted to hospital with medical emergencies

Tan, Horng Kai; Flanagan, Daniel

doi:10.1111/dme.12123

Cited by 23 publications

(16 citation statements)

References 25 publications

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“… 2 3 Hypoglycemia is also common among inpatients with diabetes, occurring in approximately 8% of admissions, and leading to a substantial increase in the length of hospital stay (LoS) and mortality. 4 5 Aside from its acute physiological effects, hypoglycemia has been associated with an elevated risk of cardiovascular events, fall-related fractures, and death, particularly among hospitalized patients, all of which add to the LoS and total cost of treatment. 6–10 …”

Section: Research Questionsmentioning

confidence: 99%

Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

McEwan

Thorsted

Wolden

et al. 2015

BMJ Open Diab Res Care

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ObjectiveUsing a retrospective cohort study, the mean length of hospital stay (LoS) and total per-patient expenditure for hypoglycemia requiring admission to hospital were estimated. In a separate matched retrospective cohort study, the effect of inpatient hypoglycemia on LoS, expenditure, and risk of all-cause mortality while admitted was investigated.MethodsThe cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). Generalized linear regression was used to estimate LoS. Risk of all-cause mortality was evaluated via logistic regression.ResultsIn the retrospective cohort study (1131 patients), mean LoS was 5.46 (95% CI 4.62 to 6.45) days for type 1 diabetes, and 5.04 (95% CI 4.46 to 5.71) days for type 2 diabetes. Mean cost per admission was £1034 (95% CI £855 to £1253). In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days (95% CI 10.96 to 12.94 days) versus 4.80 (95% CI 4.41 to 5.23) for unexposed patients, p<0.0001. Exposed patients had a higher mortality risk compared with unexposed patients (OR 1.439 (95% CI 1.060to 1.952), p=0.0195). Total average per-patient cost for exposed patients was GBP (£)2235, 40% (p<0.0001) higher than total average admission cost in unexposed patients.ConclusionsHypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure.

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Section: Research Questionsmentioning

confidence: 99%

Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

McEwan

Thorsted

Wolden

et al. 2015

BMJ Open Diab Res Care

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“…6,7 Even in patients without diabetes, hypoglycaemia on hospital admission has been linked with a significant increase in inpatient mortality and bed occupancy. 8 Patients experiencing hypoglycaemia (blood glucose <4 mmol/L) require prompt action with administration of rapidacting carbohydrate or glucagon followed by assessment of response to treatment by repeat blood glucose measurement. The Joint British Diabetes Societies inpatient care guidelines for the treatment of hypoglycaemia recommend that, following treatment of hypoglycaemia, CBG is repeated at between 10-15 minutes to ensure successful treatment.…”

Section: Introductionmentioning

confidence: 99%

Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

et al. 2015

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Aims: Hypoglycaemia confers excess morbidity and mortality. UK guidelines recommend capillary blood glucose (CBG) measurement is repeated 15 minutes following identification and treatment of CBG <4 mmol/L. We assessed adherence to this guidance, influence of initial CBG on time to repeat (TTR), and the impact of a quality improvement intervention on TTR. Conclusions: TTR is a marker of treatment quality in hypoglycaemia and is suboptimal. TTR reduces with worsening initial degree of hypoglycaemia. We have shown that a quality improvement package can produce sustained reduction of TTR. Br J Diabetes Vasc Dis 2015;15:24-26

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“…In a study of patients with uncontrolled glycemia (A1C ≥ 9.0%), insulin continuation was significantly associated with lower risks of all-cause and diabetes-related hospital readmissions [ 28 ]. In another study, hypoglycemia was found to be associated with an increased length of hospital stay and an increased in-hospital mortality rate [ 20 ]. A recent study that used Truven’s Health Analytics Commercial Claims and Encounters database identified greater costs over a 12-month period among patients with intermittent insulin use (early discontinuation and restart) compared with early discontinuation alone [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, patients’ well-being and quality of life are negatively affected by hypoglycemia, which has potential clinical sequelae including dysrhythmias [ 17 ], accidents, falls and related fractures [ 18 ], and neurological symptoms, such as dizziness and confusion. Hypoglycemia also contributes to mortality in patients with T2D [ 19 , 20 ]. Such clinical consequences can be particularly relevant in elderly patients [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization

Dalal

Kazemi

et al. 2017

Adv Ther

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IntroductionHypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D.MethodsHypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined.ResultsOf 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P < 0.001). Data, adjusted for baseline characteristics such as age, any baseline hypoglycemia, and use of oral antidiabetes drugs, showed that patients with hypoglycemia had a greater risk of discontinuation (hazard ratio 1.16; 95% confidence interval 1.03, 1.32; P = 0.0164), were more likely to have a hospitalization (41.0% vs. 24.3%; P < 0.001) or an ED visit (55.8% vs. 35.1%; P < 0.001), and had higher diabetes-related ($13,662 vs. $7506; P < 0.001) and all-cause ($30,719 vs. $19,079; P < 0.001) healthcare costs.ConclusionsUS patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden.FundingSanofi US, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0592-x) contains supplementary material, which is available to authorized users.

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The impact of hypoglycaemia on patients admitted to hospital with medical emergencies

Abstract: Hypoglycaemia is associated with an increased length of stay in hospital and an increased in-hospital mortality rate. Hypoglycaemia may have contributed to the poorer outcome, but would also appear to be a marker of disease severity in unwell patients, especially patients with sepsis.

Cited by 23 publications

References 25 publications

Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization

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