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Hypoglycemia, With or Without Insulin Therapy, Is Associated With Increased Mortality Among Hospitalized Patients
Open accessAbstract
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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Cites
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Validation of a combined comorbidity index
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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).”
ResultPreiser, J.-C., Devos, P., Ruiz-Santana, S., Mélot, C., Annane, D., Groeneveld, J., Iapichino, G., Leverve, X., Nitenberg, G., Singer, P., et al. (2009) · Intensive Care Medicine · doi:10.1007/s00134-009-1585-2 · Cited by 911
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Self-citationHypoglycemia and outcome in critically ill patients
Egi, M., Bellomo, R., Stachowski, E., French, C. J., Hart, G. K., Taori, G., Hegarty, C., & Bailey, M. (2010) · Mayo Clinic Proceedings · doi:10.4065/mcp.2009.0394 · Cited by 432
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Hypoglycemia in Hospitalized Patients
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Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients
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Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities
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“Most of these hypoglycemic episodes were treatment related, but spontaneous hypoglycemia is also known to be frequent (1).”
BackgroundResultInfluentialAssociation of Hypoglycemia With Mortality for Subjects Hospitalized With Pneumonia
Mortensen, E. M., Leykum, L. K., Nakashima, B., Restrepo, M. I., Garcia, S., & Anzueto, A. (2010) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e3181ca43fe · Cited by 23
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Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia
Umpierrez, G., & Korytkowski, M. (2016) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2016.15 · Cited by 563
Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline
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Glycemic Goals in Diabetes: Trade-off Between Glycemic Control and Iatrogenic Hypoglycemia
Cryer, P. E. (2014) · Diabetes · doi:10.2337/db14-0059 · Cited by 241
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Self-citation16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025
ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Early, K. B., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Galindo, R. J., et al. (2024) · Diabetes Care · doi:10.2337/dc25-s016 · Cited by 242
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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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