Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

  1. Alexander Turchin, MD, MS1,2,3,
  2. Michael E. Matheny, MD, MS, MPH4,5,
  3. Maria Shubina, SCD1,
  4. James V. Scanlon, PHARMD6,
  5. Bonnie Greenwood, PHARMD, BCPS1 and
  6. Merri L. Pendergrass, MD, PHD1,3,7
  1. 1Brigham and Women's Hospital, Boston, Massachusetts;
  2. 2Clinical Informatics Research and Development, Partners HealthCare System, Boston, Massachusetts;
  3. 3Harvard Medical School, Boston, Massachusetts;
  4. 4Vanderbilt Medical Center, Nashville, Tennessee;
  5. 5Tennessee Valley Healthcare System, Veteran's Administration, Nashville, Tennessee;
  6. 6Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts;
  7. 7Medco Health Solutions, Inc., Franklin Lakes, New Jersey.
  1. Corresponding author: Alexander Turchin, aturchin{at}partners.org.

Abstract

OBJECTIVE Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. It is not known whether the same risks exist for diabetic patients who are less severely ill. In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward.

RESEARCH DESIGN AND METHODS This retrospective cohort study analyzed 4,368 admissions of 2,582 patients with diabetes hospitalized in the general ward of a teaching hospital between January 2003 and August 2004. The associations between the number and severity of hypoglycemic (≤50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated.

RESULTS Hypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). LOS increased by 2.5 days for each day with hypoglycemia (P < 0.0001).

CONCLUSIONS Hypoglycemia is common in diabetic patients hospitalized in the general ward. Patients with hypoglycemia have increased LOS and higher mortality both during and after admission. Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received November 30, 2008.
    • Accepted April 6, 2009.
  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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