Inpatient hypoglycaemia: understanding who is at risk
Open Access
- 1 July 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Diabetologia
- Vol. 63 (7), 1299-1304
- https://doi.org/10.1007/s00125-020-05139-y
Abstract
Aims/hypothesis We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia. Methods The study was conducted using electronic patient record data from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for patients coded for diabetes. We used the recently agreed definition for a level 1 hypoglycaemia episode as any blood glucose measurement Results We analysed data obtained from 17,658 inpatients with diabetes (1696 with type 1 diabetes, 14,006 with type 2 diabetes, and 1956 with other forms of diabetes; 9277 men; mean +/- SD age, 66 +/- 18 years) who underwent 32,758 hospital admissions between July 2014 and August 2018. The incidence of level 1 hypoglycaemia was 21.5% and the incidence of level 2 hypoglycaemia was 9.6%. Recurrent level 1 and level 2 hypoglycaemia occurred, respectively, in 51% and 39% of hospital admissions in people with type 2 diabetes with at least one hypoglycaemic episode, and in 55% and 45% in those with type 1 diabetes. The incidence of level 2 hypoglycaemia in people with type 2 diabetes, when corrected for the number of people who remained in hospital, remained constant for the first 100 h at approximately 0.15 events per h per admission. With regards to the hypoglycaemia distribution during the day, after correcting for the number of blood glucose tests per h, there were two clear spikes in the rate of hypoglycaemia approximately 3 h after lunch and after dinner. The highest rate of hypoglycaemia per glucose test was seen between 01:00 hours and 05:00 hours. Medication had a significant impact on the incidence of level 2 hypoglycaemia, ranging from 1.5% in people with type 2 diabetes on metformin alone to 33% in people treated with a combination of rapid-acting insulin analogue, long-acting insulin analogue and i.v.-administered insulin. Conclusions/interpretation Retrospective analysis of data from electronic patient records enables clinicians to gain a greater understanding of the incidence and distribution of inpatient hypoglycaemia. This information should be used to drive evidence-based improvements in the glycaemic control of inpatients through targeted medication adjustment for specific populations at high risk of hypoglycaemia.Funding Information
- University of Oxford
This publication has 8 references indexed in Scilit:
- Importance of inpatient hypoglycaemia: impact, prediction and preventionDiabetic Medicine, 2019
- Glucose Concentrations of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of DiabetesDiabetes Care, 2016
- Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in EnglandBMJ Open Diabetes Research & Care, 2015
- Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hospitalizedDiabetic Medicine, 2012
- Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General WardDiabetes Care, 2009
- American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic ControlDiabetes Care, 2009
- Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed DiabetesJournal of Clinical Endocrinology & Metabolism, 2002
- Intensive Insulin Therapy in Critically Ill PatientsThe New England Journal of Medicine, 2001