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Mortality risk higher among inpatients with hypoglycemia
Short-term and long-term mortality are increased among hospitalized adults with or without diabetes who experience hypoglycemia, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
Amit Akirov , MD, of the Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital in Israel, and colleagues evaluated data on patients admitted to a 1,300-bed university-affiliated tertiary medical center from 2011 to 2013 on 33,675 adults (mean age, 70 years) to determine the relationship between spontaneous and insulin-related hypoglycemia and all-cause mortality. Blood glucose levels less than 70 mg/dL defined hypoglycemia; 40 mg/dL to 70 mg/dL defined moderate hypoglycemia; and less than 40 mg/dL defined severe hypoglycemia. Median follow-up was 1,022 days.
Pre-existing diabetes was present in 30% of participants, according to medical records. Participants were divided into six group according to use of insulin during hospitalization, which defined insulin-related hypoglycemia: noninsulin-treated controls (n = 27,213), insulin-treated controls (n = 3,515), noninsulin-related hypoglycemia (n = 1,594), insulin-related hypoglycemia (n = 1,011), noninsulin-related severe hypoglycemia (n = 141) and insulin-related severe hypoglycemia (n = 201).
Overall, 2,605 participants had moderate hypoglycemia, and 342 had severe hypoglycemia. In-hospital mortality was highest in the noninsulin-related severe hypoglycemia group (41.8%), followed by the insulin-related severe hypoglycemia group (24.9%), noninsulin-related hypoglycemia group (13.9%), insulin-related hypoglycemia group (12.9%), insulin-treated controls (11%) and noninsulin-treated controls (4.7%).
Overall mortality rates at the end of follow-up had a similar pattern, with the highest rate in the noninsulin-related severe hypoglycemia group (70.9%), followed by the insulin-related severe hypoglycemia group (69.1%), insulin-related hypoglycemia group (55.3%), noninsulin-related hypoglycemia group (50.7%), insulin-treated control group (42.9%) and noninsulin-treated control group (28%). Participants with severe hypoglycemia had a significantly reduced survival time after discharge compared with participants with moderate hypoglycemia.
“In our large cohort, almost one in 10 patients hospitalized to medical wards had at least one episode of hypoglycemia, including a quarter of patients treated with insulin during the hospitalization,” Akirov told Endocrine Today. “Hypoglycemia, whether insulin-related or noninsulin-related, is associated with increased short- and long-term mortality risk. With moderate hypoglycemia, mortality risk was higher in insulin-treated patients compared to patients without insulin treatment with similar glucose values. However, with severe hypoglycemia, there was no significant difference between insulin-related and noninsulin related hypoglycemia. The data are an addition to existing data showing a relationship between hypoglcycemia and subsequent mortality and importantly focuses on inpatient hypoglycemia and on hypoglycemia associated with insulin therapy. The findings are a timely reminder that hypoglycemia of any cause carries the association with increased mortality.” – by Amber Cox
For more information:
Amit Akirov , MD, can be reached at Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 49100, Irael; email: amit.akirov@gmail.com.
Disclosure: The researchers report no relevant financial disclosures.