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Cited by 127Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchPatient Safety and Medication Errors

Mortality among hospitalized patients with hypoglycemia: insulin related and noninsulin related

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Akirov, Amit, Grossman, Alon, Shochat, Tzipora, Shimon, Ilan·2017·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2016-2653
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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.(J Clin Endocrinol Metab 102: 416-424, 2017) S pontaneous and insulin-related hypoglycemia is common among hospitalized patients with and without diabetes mellitus (DM) (1, 2).The definition of hypoglycemia in hospitalized patients is poorly defined; thus, the true prevalence of hypoglycemia during hospitalization is variable.The American Diabetes Association (ADA) defines hypoglycemia as blood glucose levels ,70 mg/dL (3.9 mmol/L), and severe hypoglycemia as hypoglycemia requiring assistance from another person, characterized by cognitive impairment that may be recognized or unrecognized and can progress to loss of consciousness, seizure, coma, or death, and is reversed by administration of rapid-acting glucose.As for hospitalized patients, hypoglycemia is similarly defined as any blood glucose level ,70 mg/dL (3.9 mmol/L), and severe hypoglycemia as a blood glucose level ,40 mg/dL (2.2 mmol/L) (3).The prevalence of hypoglycemia based on a blood glucose value of ,70 mg/dL (3.9 mmol/L) varies

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  • Errors in insulin dosing, missed doses, and/or administration errors including incorrect insulin type and/or timing of dose occur relatively frequently and include prescriber, pharmacy, and nursing errors.

    “Errors in insulin dosing, missed doses, and/or administration errors including incorrect insulin type and/or timing of dose occur relatively frequently (102-104) and include prescriber (ordering), pharmacy (dispensing), and nursing (administration) errors.”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [102]

    The Discussion (page not provided) reports how often hypoglycemia occurred among hospitalized patients receiving insulin, not how often insulin-dosing or administration errors occurred. The Methods and Discussion do not address missed doses, incorrect insulin type or timing, or prescriber, pharmacy, and nursing errors; searches for those terms and for medication errors found no supporting passage. (LLM, conf=0.76)

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  1. Turchin A, Matheny ME, Shubina M, Scanlon JV, Greenwood B, Pendergrass ML. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care. 2009;32(7):1153-1157.
  2. Rubin DJ, Golden SH. Hypoglycemia in non-critically ill, hospi- talized patients with diabetes: evaluation, prevention, and man- agement. Hosp Pract (1995). 2013;41(1):109-116.
  3. Akirov A, Dicker D, Shochat T, Shimon I. Mortality risk in ad- mitted patients with diabetes mellitus according to treatment. J Diabetes Complications. 2016;30(6):1025-1031.
  4. Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821-827.
  5. Krinsley J, Schultz MJ, Spronk PE, van Braam Houckgeest F, van der Sluijs JP, Mélot C, Preiser J-C. Mild hypoglycemia is strongly associated with increased intensive care unit length of stay. Ann Intensive Care. 2011;1:49.
  6. Curkendall SM, Natoli JL, Alexander CM, Nathanson BH, Haidar T, Dubois RW. Economic and clinical impact of in- patient diabetic hypoglycemia. Endocr Pract. 2009;15(4): 302-312.
  7. Duning T, van den Heuvel I, Dickmann A, Volkert T, Wempe C, Reinholz J, Lohmann H, Freise H, Ellger B. Hypoglycemia ag- gravates critical illness-induced neurocognitive dysfunction. Di- abetes Care. 2010;33(3):639-644.
  8. Vriesendorp TM, DeVries JH, van Santen S, Moeniralam HS, de Jonge E, Roos YB, Schultz MJ, Rosendaal FR, Hoekstra JB. Evaluation of short-term consequences of hypoglycemia in an in- tensive care unit. Crit Care Med. 2006;34(11):2714-2718.
  9. Naidech AM, Levasseur K, Liebling S, Garg RK, Shapiro M, Ault ML, Afifi S, Batjer HH. Moderate hypoglycemia is asso- ciated with vasospasm, cerebral infarction, and 3-month dis- ability after subarachnoid hemorrhage. Neurocrit Care. 2010; 12(2):181-187.
  10. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, Umpierrez D, Newton C, Olson D, Rizzo M. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 sur- gery). Diabetes Care. 2011;34(2):256-261.
  11. Farrokhi F, Klindukhova O, Chandra P, Peng L, Smiley D, Newton C, Pasquel F, Fereira ME, Umpierrez G. Risk factors for inpatient hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes. J Diabetes Sci Technol. 2012;6(5): 1022-1029.
  12. Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, Knobler H. Hypoglycemia as a predictor of mortality in hospi- talized elderly patients. Arch Intern Med. 2003;163(15): 1825-1829.
  13. Fischer KF, Lees JA, Newman JH. Hypoglycemia in hospitalized pa- tients. Causes and outcomes. N Engl J Med. 1986;315(20):1245-1250.
  14. Cook CB, Potter DJ, Kongable GL. Characterizing glucose changes antecedent to hypoglycemic events in the intensive care unit. Endocr Pract. 2012;18(3):317-324.
  15. Kosiborod M, Inzucchi SE, Goyal A, Krumholz HM, Masoudi FA, Xiao L, Spertus JA. Relationship between spontaneous and iat- rogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA. 2009;301(15):1556-1564.
  16. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang Y-H, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2$7 million participants. Lancet. 2011; 378(9785):31-40.
  17. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and pre- diabetes prevalence. Popul Health Metr. 2010;8:29.
  18. Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitali- zations for patients with diabetes. Diabetes Care. 2003;26(5): 1421-1426.

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Authors
Akirov, A., Grossman, A., Shochat, T., & Shimon, I.
Affiliations
  • Tel Aviv University (IL)
  • Rabin Medical Center (IL)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2016-11-17
Volume
102
Issue
2
Pages
416-424
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2016-2653
OpenAlex
W2549916047
Cited by
127
References
0
Citations by year
2026: 7 · 2025: 17 · 2024: 15 · 2023: 18 · 2022: 8 · 2021: 14 · 2020: 22 · 2019: 11 · 2018: 13 · 2017: 2
FWCI
8.72
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
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, mortality, hospitalized patients, severe hypoglycemia, insulin therapy, diabetes mellitus, medical inpatients, all-cause mortality, mortality risk factors, blood glucose monitoring, glycemic control
MeSH terms
Aged, Blood Glucose, Female, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Israel, Male, Middle Aged, Prospective Studies, Comorbidity, Hospital Mortality, Kaplan-Meier Estimate

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