V Borzì1, S Frasson2, G Gussoni3, M Di Lillo4, R Gerloni5, G Augello6, G Gulli7, A Ceriello8, B Solerte9, E Bonizzoni10, A Fontanella11. 1. Department of Internal Medicine, Hospital "Policlinico Vittorio Emanuele", Catania, Italy. 2. Clinical Research Department, FADOI Foundation, Milan, Italy. Electronic address: stefania.frasson@fadoi.org. 3. Clinical Research Department, FADOI Foundation, Milan, Italy. 4. Department of Emergency, Azienda Ospedali Marche Nord Santa Croce di Fano, Pesaro e Urbino, Italy. 5. Department of Internal Medicine, Ospedali Riuniti di Trieste University Hospital, Trieste, Italy. 6. Department of Internal Medicine, Barone Lombardo Hospital, Canicattì, Italy. 7. Department of Internal Medicine, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy. 8. Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 9. Department of Internal Medicine, University Hospital of Pavia, Pavia, Italy. 10. Section of Medical Statistics and Biometry GA Maccacaro, Department of Clinical Science and Community, University of Milan, Milan, Italy. 11. Department of Internal Medicine, Fatebenefratelli Hospital, Naples, Italy.
Abstract
AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay. The association between occurrence of hypoglycemia and potential predictors was evaluated by means of a multivariable logistic regression analysis. RESULTS: A total of 385 symptomatic hypoglycemic events were observed (rate=12%). Advanced age, cognitive dysfunction, and nephropathy were associated with hypoglycemia. Hypoglycemia occurred in 19.4% of patients treated according to the insulin sliding-scale method versus 11.4% of patients treated with basal bolus (p<0.01). More patients with hypoglycemia received sulfonylureas versus the no-hypoglycemia group (28.3% versus 20.6%, p<0.001). Significantly longer length of hospital stay and increased in-hospital mortality were found in the group with hypoglycemia compared with the no-hypoglycemia group (12.7±10.9 versus 9.6±6.5 days; 8.8% versus 4.8%, p<0.01). CONCLUSIONS: Hypoglycemia in hospitalized patients with diabetes is associated with increased length of hospitalization and in-hospital mortality. Identification of patients at increased risk of hypoglycemia may be important for optimally adapting treatment and patient management.
AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay. The association between occurrence of hypoglycemia and potential predictors was evaluated by means of a multivariable logistic regression analysis. RESULTS: A total of 385 symptomatic hypoglycemic events were observed (rate=12%). Advanced age, cognitive dysfunction, and nephropathy were associated with hypoglycemia. Hypoglycemia occurred in 19.4% of patients treated according to the insulin sliding-scale method versus 11.4% of patients treated with basal bolus (p<0.01). More patients with hypoglycemia received sulfonylureas versus the no-hypoglycemia group (28.3% versus 20.6%, p<0.001). Significantly longer length of hospital stay and increased in-hospital mortality were found in the group with hypoglycemia compared with the no-hypoglycemia group (12.7±10.9 versus 9.6±6.5 days; 8.8% versus 4.8%, p<0.01). CONCLUSIONS:Hypoglycemia in hospitalized patients with diabetes is associated with increased length of hospitalization and in-hospital mortality. Identification of patients at increased risk of hypoglycemia may be important for optimally adapting treatment and patient management.
Authors: Bettina Hartmann; Stefanie Lanzinger; Peter Bramlage; Felix Groß; Thomas Danne; Siegfried Wagner; Dietmar Krakow; Artur Zimmermann; Christian Malcharzik; Reinhard W Holl Journal: PLoS One Date: 2017-08-21 Impact factor: 3.240