January 13, 2017
Hospital Patients Twice as Likely to Die With Hypoglycemia
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