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Cited by 180Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchPatient Safety and Medication Errors

Hypoglycemia, with or without insulin therapy, is associated with increased mortality among hospitalized patients

Open access
Garg, Rajesh, Hurwitz, Shelley, Turchin, Alexander, Trivedi, Apoorva·2013·Diabetes Care
DOI 10.2337/dc12-1296PMC PMC3631882
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Abstract

OBJECTIVE: Hypoglycemia is associated with increased mortality in hospitalized patients. We investigated the relationship between spontaneous hypoglycemia versus insulin-associated hypoglycemia and mortality in hospitalized patients. RESEARCH DESIGN AND METHODS: Data for this retrospective cohort study were obtained from electronic databases of patients admitted between 1 April 2008 and 30 November 2010. Patients with one or more blood glucose values ≤50 mg/dL on point-of-care glucose testing were considered hypoglycemic. Patients treated with insulin were assumed to have insulin-associated hypoglycemia. Age-, sex-, and race-matched patients with all blood glucose values >70 mg/dL were selected as controls. The Charlson comorbidity index (CCI) was used to control for severity of illness. RESULTS: There were four groups: 1) noninsulin-treated hypoglycemia (NTH) (n = 135), 2) insulin-treated hypoglycemia (ITH) (n = 961), 3) noninsulin-treated control (NTC) (n = 1,058), and 4) insulin-treated control (ITC) (n = 736). Mortality was higher in the ITH group compared with the ITC group (20.3 vs. 4.5%, P < 0.0001), with a relatively higher CCI (1.8 vs. 1.5%, P < 0.0001), but much higher in the NTH group compared with the NTC group (34.5 vs. 1.1%, P < 0.0001), with much higher CCI (2.4 vs. 1.1%, P < 0.0001). Mortality was higher in the NTH group compared with the ITH group (P < 0.0001) but lower in the NTC group compared with the ITC group (P < 0.0001). After controlling for age, sex, CCI, and admission to the intensive care unit, insulin treatment was associated with a lower mortality among the hypoglycemic patients; hazard ratio of death in the ITH group relative to the NTH group was 0.34 (95% CI 0.25-0.47, P < 0.0001). CONCLUSIONS: Insulin-associated and spontaneous hypoglycemia are associated with increased mortality among hospitalized patients.

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  • In many cases, hypoglycemia is a marker of an underlying disease rather than the cause of fatality.

    “While hypoglycemia is associated with increased mortality (97,98), in many cases, it is a marker of an underlying disease rather than the cause of fatality.”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [98]

    The introduction following the Abstract Conclusions says patients with more severe illnesses are more likely to develop hypoglycemia and have a higher risk of death, supporting the idea that hypoglycemia can mark underlying illness. But the Conclusions say whether hypoglycemia causes increased mortality remains unclear; the paper does not establish that, in many cases, illness rather than hypoglycemia caused the fatality. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Hypoglycemia is associated with increased mortality.

    “While hypoglycemia is associated with increased mortality (97,98), in many cases, it is a marker of an underlying disease rather than the cause of fatality.”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [98]

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Authors
Garg, R., Hurwitz, S., Turchin, A., & Trivedi, A.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Garg, Rajesh
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2013-04-13
Volume
36
Issue
5
Pages
1107-1110
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc12-1296
PMC
PMC3631882
OpenAlex
W2130532045
Cited by
176
References
17
Citations by year
2026: 5 · 2025: 10 · 2024: 9 · 2023: 12 · 2022: 14 · 2021: 12 · 2020: 19 · 2019: 11 · 2018: 14 · 2017: 13 · 2016: 19 · 2015: 17 · 2014: 12 · 2013: 9
FWCI
9.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
National Center for Research Resources (UL1RR025758)
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
insulin therapy, mortality, hospitalized patients, spontaneous hypoglycemia, blood glucose, intensive care unit admission, comorbidities, point-of-care glucose testing, critically ill patients, diabetes management, glycemic control, mortality risk factors, mortality risk stratification
MeSH terms
Female, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Retrospective Studies, Hospital Mortality

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