The risk factors of inpatient hypoglycemia: A systematic review

Abstract

Hypoglycemia is an important and harmful complication of Diabetes Mellitus (DM) that often occurs in inpatient or outpatient settings. Hypoglycemia can be divided into two types, i.e. primary hypoglycemia when hypoglycemia is the main diagnosis for admission, whereas secondary hypoglycemia if hypoglycemia occurs during hospitalization. Hypoglycemia during hospitalization or secondary hypoglycemia may arise from various risk factors, such as advanced age, comorbid diseases, type of diabetes, previous history of hypoglycemia, body mass index, hyperglycemia therapy given, as well as other risk factors such as inadequate glucose monitoring, unclear or unreadable physician instructions, limited health personnel, limited facilities, prolonged fasting and incompatibility of nutritional intake and therapy administered. Hypoglycemia can lead to medical and non-medical impacts, such as increased mortality, cardiovascular disorders, cerebrovascular disorders, and increased health care costs and length of stay. The incidence of inpatient hypoglycemia can actually be prevented by controlling modifiable risk factors and also giving education about hypoglycemia to patients and health workers. We performed a literature research in Pubmed, EBSCOhost, and Scopus to review the possible risk factors for inpatient hypoglycemia. Eleven studies were retrieved. We presented the result of these studies as well as a brief overview of the epidemiology, pathophysiology, impact and preventive strategy.

A prospective six-month audit of inpatient hypoglycemia in step-down general medical and geriatric wards

“…On admission (the first occasion if there were subsequent hospitalizations) they were of mean±SD age 73.1±12.5 (range 44.1-96.7) years, 34 (57.6%) were males, and 51 (86.4%) had type 2 diabetes. Diabetes duration, available for 35 patients, was a median [inter-quartile range (IQR)] 20 [15][16][17][18][19][20][21][22][23][24][25][26][27][28] years. The majority of the 59 patients (78.9%) were insulin-treated, and 12.5% were taking a sulfonylurea with one of these also using insulin.…”

Fasting biochemical hypoglycemia and related-factors in non-diabetic population: Kanagawa Investigation of Total Check-up Data from National Database-8

“…Hypoglycemia frequently occurs in diabetic patients undergoing pharmacotherapy and is difficult to predict[ 1 - 4 ]. In the present study, we have demonstrated that FBH also occurs in non-diabetic people, although the prevalence was very low (less than 1.0% of the total) in the general population studied, in contrast to that in diabetic patients[ 12 , 13 ].…”

“…Fasting plasma glucose was measured (approximately 54% of samples) mainly by spectrophotometric or potentiometric (approximately 30%) method[ 8 ]. FBH was defined as an FPG < 70 mg/dL (3.9 mmol/L), regardless of the presence or absence of symptoms[ 4 , 10 ]. Laboratory measurements were performed using standard automated methods.…”

“…Hypoglycemia is one of the most serious complications during the treatment of diabetes, whether it be type 1, type 2, or another type[ 1 - 4 ]. Hypoglycemia is associated with high mortality due to cardiovascular events and impaired cognitive function.…”

“…Hypoglycemia is associated with high mortality due to cardiovascular events and impaired cognitive function. The prevalence and severity of hypoglycemia, which is particularly frequent in diabetic patients who are administering insulin[ 1 - 4 ], are affected by multiple factors, including medication, diet, exercise, and the presence of comorbidities. However, the clinical relevance of hypoglycemia is poorly understood in people who do not have diabetes, and its prevalence has been determined in only a few small studies[ 5 - 7 ].…”