CoChat
Sign Up
Cited by 175Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchPatient Safety and Medication Errors

Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities

Open access
Boucai, Laura, Southern, William N., Zonszein, Joel·2011·The American Journal of Medicine
DOI 10.1016/j.amjmed.2011.07.011PMC PMC3200530
Open this paper in CoChat — free account

Abstract

Objective Although tight glucose control is used widely in hospitalized patients, there is concern that medication-induced hypoglycemia may worsen patient outcomes. We sought to determine if the mortality risk associated with hypoglycemia in hospitalized noncritically ill patients is linked to glucose-lowering medications (drug-associated hypoglycemia) or merely an association mediated by comorbidities (spontaneous hypoglycemia).Methods A retrospective cohort of patients admitted to the general wards of an academic center during 2007 was studied. The in-hospital mortality risk of a hypoglycemic group (at least 1 blood glucose ≤ 70 mg/dL) was compared with that of a normoglycemic group using survival analysis. Stratification by subgroups of patients with spontaneous and drug-associated hypoglycemia was performed.Results Among 31,970 patients, 3349 (10.5%) had at least 1 episode of hypoglycemia. Patients with hypoglycemia were older, had more comorbidities, and received more antidiabetic agents. Hypoglycemia was associated with increased in-hospital mortality (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.33-2.09; P<.001). However, this greater risk was limited to patients with spontaneous hypoglycemia (HR, 2.62; 95% CI, 1.97-3.47; P<.001) and not to patients with drug-associated hypoglycemia (HR, 1.06; 95% CI, 0.74-1.52; P=.749). After adjustment for patient comorbidities, the association between spontaneous hypoglycemia and mortality was eliminated (HR, 1.11; 95% CI, 0.76-1.64; P=.582).Conclusion Drug-associated hypoglycemia was not associated with increased mortality risk in patients admitted to the general wards. The association between spontaneous hypoglycemia and mortality was eliminated after adjustment for comorbidities, suggesting that hypoglycemia may be a marker of disease burden rather than a direct cause of death.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.amjmed.2011.07.011

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Risk factors for inpatient hypoglycemia include older age, presence of comorbidities, diabetes, increasing number of antidiabetic agents, tight glycemic control, septic shock, renal insufficiency, mechanical ventilation, and severity of illness.

    “The risk factors for inpatient hypoglycemia include older age, presence of comorbidities, diabetes, increasing number of antidiabetic agents, tight glycemic control, septic shock, renal insufficiency, mechanical ventilation, and severity of illness (75,76).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [75]

    The Results (Baseline characteristics; page not provided) report that patients who developed hypoglycemia were older, had more comorbidities including diabetes, and more often received certain antidiabetic drugs. The paper also reports higher hypoglycemia rates with intensive glucose control and includes shock and renal failure as covariates. It does not establish an increasing number of antidiabetic agents, septic shock specifically, mechanical ventilation, or overall illness severity as risk factors for inpatient hypoglycemia. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In a retrospective study of 31,970 patients admitted to general wards of an academic medical center in 2007, 3,349 patients (10.5%) had at least one episode of hypoglycemia (≤70 mg/dL).

    “In a retrospective study of 31,970 patients admitted to the general wards of an academic medical center in 2007, a total of 3,349 patients (10.5%) had at least one episode of hypoglycemia (≤70 mg/dL) (75).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [75]

  • Oral DPP-4 inhibitors have been tested in RCTs in medical and surgical noncritically ill patients with mild hyperglycemia (admission glucose <180 mg/dL).

    “Oral DPP-4 inhibitors have been tested in RCTs in medical and surgical noncritically ill persons with mild hyperglycemia (admission glucose <180 mg/dL).1351,1354–1357”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1357]

    The Study Population section (page unavailable) describes a retrospective cohort of general-ward patients, not an RCT. Searches for DPP-4 inhibitors, sitagliptin, and the admission-glucose threshold found no passage reporting the claimed trials; the trials mentioned in the References concern other treatments or settings. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • DPP-4 inhibitors plus low-dose basal insulin were as effective as basal-bolus insulin and were linked to less hypoglycemia and less treatment burden.

    “DPP-4 inhibitors combined with low-dose basal insulin have been similarly effective to basal-bolus insulin and associated with less hypoglycemia and less treatment burden.1351,1354–1357,1359”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1357]

    The Results (Baseline characteristics and Unadjusted association between hypoglycemia and mortality; page not provided) examine hypoglycemia in hospitalized patients, not DPP-4 inhibitors combined with low-dose basal insulin. Searches for that combination and for a basal-bolus comparison found no passage addressing comparable effectiveness, less hypoglycemia, or treatment burden. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In a retrospective study of 31,970 patients admitted to the general wards of an academic medical center in 2007, 3,349 patients (10.5%) had at least one episode of hypoglycemia ≤70 mg/dL.

    “In a retrospective study of 31,970 patients admitted to the general wards of an academic medical center in 2007, a total of 3,349 patients (10.5%) had at least one episode of hypoglycemia ( # 70 mg/dL) (75).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [75]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Boucai, L., Southern, W. N., & Zonszein, J.
Affiliations
Albert Einstein College of Medicine (US)
Corresponding author
Boucai, Laura
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2011-11
Volume
124
Issue
11
Pages
1028-1035
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/j.amjmed.2011.07.011
PMC
PMC3200530
OpenAlex
W2018247534
Cited by
175
References
33
Citations by year
2026: 6 · 2025: 6 · 2024: 9 · 2023: 15 · 2022: 10 · 2021: 9 · 2020: 11 · 2019: 12 · 2018: 9 · 2017: 11 · 2016: 22 · 2015: 16 · 2014: 11 · 2013: 13 · 2012: 14
FWCI
10.22
Type
journal article
Language
en
Open access
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Center for Research Resources
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
hypoglycemia, in-hospital mortality, spontaneous hypoglycemia, glucose-lowering medications, comorbidities, tight glycemic control, antidiabetic drugs
MeSH terms
Adult, Aged, Aged, 80 and over, Blood Glucose, Cause of Death, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, New York City, Retrospective Studies, Risk, Risk Factors, Cohort Studies, Comorbidity, Proportional Hazards Models, Survival Analysis, Hospital Mortality

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review