This runs against what was said about
six years ago. Then it was hyperglycemia that was the problem for
people with diabetes when hospitalized. You were often required to have blood
glucose readings of 180 mg/dl or higher.
Now hospitalized patients who
experience low blood glucose levels are at substantially increased
risk of death, both over the short term and after discharge, compared
with those who don't have hypoglycemia, regardless of their diabetes
status, new results from a large-scale study indicate.
The findings show that, in hospitalized
patients with spontaneous and insulin-related hypoglycemia, the
mortality risk is more than doubled, rising to an approximately
fourfold increased risk of death in patients with severe hypoglycemia
(compared with those without hypoglycemia).
The research, which was published
online recently in the Journal of Clinical
Endocrinology & Metabolism, coincides with the publication
of a series of recommendations to tackle the threat of hypoglycemia
to diabetes patients.
Noting that hypoglycemia is common among hospitalized patients, regardless of diabetes status, lead
researcher Amit Akirov, MD, Institute of Endocrinology, Rabin Medical
Center-Beilinson Hospital, Petach Tikva, Israel, said: "These
data are a timely reminder that hypoglycemia of any cause carries the
association with increased mortality."
And Dr Akirov told Medscape Medical
News that the finding that death rates are higher with severe vs
moderate hypoglycemia "indicates a possible dose-dependent
effect — a decrease in blood glucose levels is associated with an
increase in mortality rates."
However, although he and his coauthors
put forward several potential explanations as to why hypoglycemia may
be associated with increased mortality risk, there remain a number of
unanswered questions.
He said: "There is some
controversy regarding the importance of blood glucose levels, as some
claim this is a real cause for increased mortality, while others
believe this is a marker of the general status of the patient.
Further research is needed to try to find the answer to this
question."
As most hospitalized patients get
routine blood tests, and these usually include glucose levels, "there
is probably no need for a specific recommendation" to do
this, he said, but stressed that it's important to have this
information on admission.
Implications of Hypoglycemia Are
Unclear. Although it is known that spontaneous and insulin-related
hypoglycemia are common in hospitalized patients, both with and
without diabetes, the definition of hypoglycemia in hospitalized
patients is inconsistent, and so the true prevalence and prognostic
implications remain unclear.
To examine the association between
hypoglycemia and mortality in hospitalized patients, Dr Akirov and
colleagues defined hypoglycemia as a blood glucose level less than 70
mg/dl (3.9 mmol/L), which was stratified into moderate hypoglycemia
(40–70 mg/dl, 2.2–3.9 mmol/L) and severe hypoglycemia (less than
40 mg/dl, 2.2 mmol/L).
His team gathered data on all first
admissions to an Israeli 1300-bed tertiary medical center with 10
medical wards between January 2011 and December 2013. Mortality data
were obtained to June 2015, with the medical database used to collate
self-reported data on alcohol use, smoking, and body mass index, as
well as the presence of comorbidities.
Diabetes was defined as a previous
diagnosis of diabetes in medical records or use of any oral
hypoglycemic agent, glucagon-like peptide 1 (GLP-1) agonist, or
insulin at admission.
Patients were therefore divided into:
non–insulin-treated controls (NITC) and insulin-treated controls
(ITC), non–insulin-related hypoglycemia (NIH) and
non–insulin-related severe hypoglycemia (NISH), and insulin-related
hypoglycemia (IH) and insulin-related severe hypoglycemia (ISH).
From an overall cohort of 33,675
patients, 2947 (9%) were identified to have at least one blood
glucose value less than 70 mg/dl
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