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

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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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Research works printed but not linked: 17

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  2. Rubin, 2013, Hypoglycemia in non-critically ill, hospitalized patients with diabetes: evaluation, prevention, and management, Hosp Pract (1995), 41, 109, 10.3810/hp.2013.02.1016 · DOI
  3. Akirov, 2016, Mortality risk in admitted patients with diabetes mellitus according to treatment, J Diabetes Complications, 30, 1025, 10.1016/j.jdiacomp.2016.04.011 · DOI
  4. Griesdale, 2009, Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data, CMAJ, 180, 821, 10.1503/cmaj.090206 · DOI · Paper page
  5. Krinsley, 2011, Mild hypoglycemia is strongly associated with increased intensive care unit length of stay, Ann Intensive Care, 1, 49, 10.1186/2110-5820-1-49 · DOI
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Metadata

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 › Medicine › Public Health, Environmental and Occupational Health › 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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