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Cited by 49Acute Kidney Injury ResearchDiabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patients

Risk of hypoglycemia following hospital discharge in patients with diabetes and acute kidney injury

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Hung, Adriana M., Siew, Edward D., Wilson, Otis D., Perkins, Amy M., Greevy, Robert A., Horner, Jeffrey, Abdel-Kader, Khaled, Parr, Sharidan K. +5 more·2018·Diabetes Care
DOI 10.2337/dc17-1237PMC PMC5829959
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Abstract

OBJECTIVE: Hypoglycemia is common in patients with diabetes. The risk of hypoglycemia after acute kidney injury (AKI) is not well defined. The purpose of this study was to compare the risk for postdischarge hypoglycemia among hospitalized patients with diabetes who do and do not experience AKI. RESEARCH DESIGN AND METHODS: We performed a propensity-matched analysis of patients with diabetes, with and without AKI, using a retrospective national cohort of veterans hospitalized between 2004 and 2012. AKI was defined as a 0.3 mg/dL or 50% increase in serum creatinine from baseline to peak serum creatinine during hospitalization. Hypoglycemia was defined as hospital admission or an emergency department visit for hypoglycemia or as an outpatient blood glucose <60 mg/dL. Time to incident hypoglycemia within 90 days postdischarge was examined using Cox proportional hazards models. Prespecified subgroup analyses by renal recovery, baseline chronic kidney disease, preadmission drug regimen, and HbA1c were performed. RESULTS: We identified 65,151 propensity score–matched pairs with and without AKI. The incidence of hypoglycemia was 29.6 (95% CI 28.9–30.4) and 23.5 (95% CI 22.9–24.2) per 100 person-years for patients with and without AKI, respectively. After adjustment, AKI was associated with a 27% increased risk of hypoglycemia (hazard ratio [HR] 1.27 [95% CI 1.22–1.33]). For patients with full recovery, the HR was 1.18 (95% CI 1.12–1.25); for partial recovery, the HR was 1.30 (95% CI 1.23–1.37); and for no recovery, the HR was 1.48 (95% CI 1.36–1.60) compared with patients without AKI. Across all antidiabetes drug regimens, patients with AKI experienced hypoglycemia more frequently than patients without AKI, though the incidence of hypoglycemia was highest among insulin users, followed by glyburide and glipizide users, respectively. CONCLUSIONS: AKI is a risk factor for hypoglycemia in the postdischarge period. Studies to identify risk-reduction strategies in this population are warranted.

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  • Kidney failure is an important risk factor for hypoglycemia in the hospital, possibly as a result of decreased insulin clearance.

    “Kidney failure is an important risk factor for hypoglycemia in the hospital (105), possibly as a result of decreased insulin clearance.”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [105]

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Authors
Hung, A. M., Siew, E. D., Wilson, O. D., Perkins, A. M., Greevy, R. A., Horner, J., Abdel-Kader, K., Parr, S. K., Roumie, C. L., Griffin, M. R., Ikizler, T. A., Speroff, T., & Matheny, M. E.
Affiliations
  • Vanderbilt University (US)
  • Veterans Health Administration (US)
Corresponding author
Hung, Adriana M.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2018-01-11
Volume
41
Issue
3
Pages
503-512
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc17-1237
PMC
PMC5829959
OpenAlex
W2782926404
Cited by
49
References
3
Citations by year
2026: 5 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 13 · 2019: 5 · 2018: 1
FWCI
5.33
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 40 d)
Locations
  • Diabetes Care (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Department of Veterans Affairs, Australian Government (1I01CX000982-01A1, IIR 13-073)
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
hypoglycemia, acute kidney injury, diabetes mellitus, renal function recovery, antidiabetic drugs, insulin, glibenclamide, glipizide, veterans, chronic kidney disease, HbA1c, glycemic control, hospital discharge, emergency department visits, veterans health system
MeSH terms
Adult, Aged, Blood Glucose, Diabetes Mellitus, Diabetic Nephropathies, Female, Glyburide, Glipizide, Humans, Hypoglycemia, Kidney Function Tests, Male, Middle Aged, Patient Discharge, Retrospective Studies, Risk Factors, Acute Kidney Injury

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