Yoojin Kim1, Kumar B Rajan2, Shannon A Sims3, Kristen E Wroblewski4, Sirimon Reutrakul5. 1. Section of Endocrinology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA. 2. Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA. 3. Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA. 4. Department of Health Studies, University of Chicago, Chicago, IL, USA. 5. Section of Endocrinology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA; Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sreutrakul@yahoo.com.
Abstract
AIMS: To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia. METHODS: A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF). RESULTS: There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2 ± 11.1. Hypoglycemia (POCG ≤70 mg/dl [3.9 mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p=0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p=0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p=<0.001] and an increase of 2 days in LOS for those with average %CV. CONCLUSIONS: Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.
AIMS: To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia. METHODS: A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF). RESULTS: There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2 ± 11.1. Hypoglycemia (POCG ≤70 mg/dl [3.9 mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p=0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p=0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p=<0.001] and an increase of 2 days in LOS for those with average %CV. CONCLUSIONS:Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.
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