Amit Akirov1,2, Alon Grossman3,2, Tzipora Shochat4, Ilan Shimon1,2. 1. Institute of Endocrinology. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel. 3. Department of Internal Medicine E, and. 4. Statistical Consulting Unit, Rabin Medical Center-Beilinson Hospital, Petach Tikva 49100, Israel; and.
Abstract
CONTEXT: Hypoglycemia is common among hospitalized patients with and without diabetes mellitus. OBJECTIVE: Investigate the association between spontaneous or insulin-related hypoglycemia and mortality in hospitalized patients. DESIGN: Hypoglycemia was defined as blood glucose <70 mg/dl (3.9 mmol/l), including moderate (40 to 70 mg/dl, 2.2 to 3.9 mmol/l) and severe hypoglycemia (<40 mg/dl, 2.2 mmol/l). Use of insulin during hospitalization defined insulin-related hypoglycemia, thus patients were classified into 6 groups: non-insulin treated (NITC) and insulin-treated controls (ITC), insulin-related hypoglycemia (IH) or severe hypoglycemia (ISH), and non insulin-related hypoglycemia (NIH) and severe hypoglycemia (NISH). SETTING AND PATIENTS: Historical prospectively data of patients ≥ 18 years of age, hospitalized in medical wards for any cause between January 2011 and December 2013. MAIN OUTCOME MEASURE: All-cause mortality at the end of follow-up. RESULTS: The cohort included 33,675 patients, including 2605 with moderate hypoglycemia (IH, 1011; NIH, 1594) and 342 with severe hypoglycemia (ISH, 201; NISH,141). Overall end-of-follow-up mortality was 31.9% (NITC, 28.0%; ITC, 42.9%; NIH, 50.7%; IH, 55.3%; NISH, 70.9%; ISH, 69.1%). Compared with NITC, unadjusted hazard ratios (95% confidence intervals) for mortality were as follows: ITC, 1.7 (1.6 to 1.8), NIH, 2.2 (2.0 to 2.4), IH, 2.5 (2.2 to 2.7), NISH, 4.2 (3.5 to 5.2), and ISH, 3.8 (3.2 to 4.5); with P < 0.001. Following multivariate analysis, respective hazard ratios were 1.8, 2.1, 2.4, 3.2, and 3.6 (P < 0.001). Cause of admission did not affect the association. CONCLUSIONS: In hospitalized patients, hypoglycemia, either with insulin use or spontaneous, is associated with increased short- and long-term mortality.
CONTEXT: Hypoglycemia is common among hospitalized patients with and without diabetes mellitus. OBJECTIVE: Investigate the association between spontaneous or insulin-related hypoglycemia and mortality in hospitalized patients. DESIGN: Hypoglycemia was defined as blood glucose <70 mg/dl (3.9 mmol/l), including moderate (40 to 70 mg/dl, 2.2 to 3.9 mmol/l) and severe hypoglycemia (<40 mg/dl, 2.2 mmol/l). Use of insulin during hospitalization defined insulin-related hypoglycemia, thus patients were classified into 6 groups: non-insulin treated (NITC) and insulin-treated controls (ITC), insulin-related hypoglycemia (IH) or severe hypoglycemia (ISH), and non insulin-related hypoglycemia (NIH) and severe hypoglycemia (NISH). SETTING AND PATIENTS: Historical prospectively data of patients ≥ 18 years of age, hospitalized in medical wards for any cause between January 2011 and December 2013. MAIN OUTCOME MEASURE: All-cause mortality at the end of follow-up. RESULTS: The cohort included 33,675 patients, including 2605 with moderate hypoglycemia (IH, 1011; NIH, 1594) and 342 with severe hypoglycemia (ISH, 201; NISH,141). Overall end-of-follow-up mortality was 31.9% (NITC, 28.0%; ITC, 42.9%; NIH, 50.7%; IH, 55.3%; NISH, 70.9%; ISH, 69.1%). Compared with NITC, unadjusted hazard ratios (95% confidence intervals) for mortality were as follows: ITC, 1.7 (1.6 to 1.8), NIH, 2.2 (2.0 to 2.4), IH, 2.5 (2.2 to 2.7), NISH, 4.2 (3.5 to 5.2), and ISH, 3.8 (3.2 to 4.5); with P < 0.001. Following multivariate analysis, respective hazard ratios were 1.8, 2.1, 2.4, 3.2, and 3.6 (P < 0.001). Cause of admission did not affect the association. CONCLUSIONS: In hospitalized patients, hypoglycemia, either with insulin use or spontaneous, is associated with increased short- and long-term mortality.
Authors: Lakshmi G Singh; David L Levitt; Medha Satyarengga; Lillian Pinault; Min Zhan; John D Sorkin; Jeffrey C Fink; Guillermo E Umpierrez; Elias K Spanakis Journal: J Diabetes Sci Technol Date: 2019-11-28
Authors: Elias K Spanakis; Guillermo E Umpierrez; Tariq Siddiqui; Min Zhan; Soren Snitker; Jeffrey C Fink; John D Sorkin Journal: J Clin Endocrinol Metab Date: 2019-09-01 Impact factor: 5.958