Mortality Among Hospitalized Patients With Hypoglycemia: Insulin Related and Noninsulin Related

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