Diabetes Metab J.  2020 Aug;44(4):555-565. 10.4093/dmj.2019.0064.

Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence

• Lee J
• Kim TM
• Kim H
• Lee SH
• Cho JH
• Lee H
• Yim HW
• Yoon KH
• Kim HS

• KMID: 2513015
• DOI: http://doi.org/10.4093/dmj.2019.0064

Abstract

Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward.

This retrospective study included patients who were admitted between 2009 and 2018. Patients were provided regular meals at fixed times according to ideal body weights during hospitalization. We categorized the patients into two groups: those with and those without hypoglycemia during hospitalization.

Of the 3,031 patients, 379 experienced at least one episode of hypoglycemia during hospitalization (HYPO group). Hypoglycemia occurred more frequently particularly in cases of premixed insulin therapy. Compared with the control group, the HYPO group was older (61.0±16.8 years vs. 59.1±16.5 years, P=0.035), with more females (60.4% vs. 49.6%, P<0.001), lower body mass index (BMI) (23.5±4.2 kg/m² vs. 25.1±4.4 kg/m², P<0.001), and higher prevalence of type 1 diabetes mellitus (6.1% vs. 2.6%, P<0.001), They had longer hospital stay (11.1±13.5 days vs. 7.6±4.6 days, P<0.001). After discharge the HYPO group had lower glycosylated hemoglobin reduction rate (−2.0%±0.2% vs. −2.5%±0.1%, P=0.003) and tended to have more frequent cases of cardiovascular disease.

Hypoglycemia occurred more frequently in older female patients with lower BMI and was associated with longer hospital stay and poorer glycemic control after discharge. Therefore, clinicians must carefully ensure that patients do not experience hypoglycemia during hospitalization.

Keyword

Diabetes mellitus; Hospitalization; Hypoglycemia; Mortality

Figure

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  Fig. 1 Comparison of (A) length of hospital stay and (B) glycosylated hemoglobin (HbA1c) level after discharge between patients with and without hypoglycemia. aDenotes a statistically significant difference in length of hospital stay between hypoglycemic group and control group (P=0.01).

• 

  Fig. 2 Kaplan-Meier survival curves for (A) heart failure, (B) hypertensive disease, (C) angina, (D) acute myocardial infarction, (E) ischemic heart disease, and (F) renal failure among patients with and without hypoglycemia.

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