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Hypoglycemia, With or Without Insulin Therapy, Is Associated With Increased Mortality Among Hospitalized Patients
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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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“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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“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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“Most studies, in the inpatient setting as well as in the outpatient setting, have demonstrated that spontaneous hypoglycemia is associated with increasedmortality as compared with insulin-induced hypoglycemia, and our study supports these data (7,16,17).”
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Metadata
- Authors
- Garg, R., Hurwitz, S., Turchin, A., & Trivedi, A.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Garg, Rajesh
- 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
- 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
- hybrid
- doi.org
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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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