Akirov A, Grossman A, Shochat T, Shimon I. Mortality among hospitalized patients with hypoglycemia: insulin-related and non-insulin related. The Journal of Clinical Endocrinology & Metabolism. http://press.endocrine.org/doi/abs/10.1210/jc.2016-2653
Context: Hypoglycemia is common among hospitalized patients with and without diabetes mellitus (DM) but the prognostic implications may differ with spontaneous versus insulin-related hypoglycemia.
Objective: Investigate the association between spontaneous or insulin-related hypoglycemia and mortality in hospitalized patients.
Design: Hypoglycemia was defined as blood glucose <70mg/dl (3.9 mmol/l), including moderate hypoglycemia (40-70mg/dl, 2.2-3.9 mmol/l) and severe hypoglycemia (<40mg/dl, 2.2 mmol/l). Use of insulin during hospitalization defined insulin-related hypoglycemia, thus patients were classified into 6 groups: non-insulin treated (NITC) and insulin-treated controls (ITC), insulin-related hypoglycemia (IH) or severe hypoglycemia (ISH), and non insulin-related hypoglycemia (NIH) and severe hypoglycemia (NISH).
Setting: Historical prospectively data of patients hospitalized to medical wards for any-cause between January 2011 and December 2013.
Patients: Patients ≥18 years.
Main outcome: All-cause mortality at the end of follow-up.
Results: Cohort included 33,675 patients. 2,947 had at least one glucose value <70 mg/dl (3.9 mmol/l) (9%), including 2,605 with moderate hypoglycemia (IH=1,011, NIH=1,594) and 342 with severe hypoglycemia (ISH=201, NISH=141). Overall end of follow-up mortality was 31.9% (NITC=28.0%, ITC=42.9%, NIH=50.7%, IH=55.3%, NISH=70.9%, ISH=69.1%). Compared with non-insulin treated controls, unadjusted hazard ratios (95% CI) for mortality were as follows: ITC, 1.7 (1.6-1.8), NIH, 2.2 (2.0-2.4), IH, 2.5 (2.2-2.7), NISH, 4.2 (3.5-5.2), and ISH, 3.8 (3.2-4.5) (p<.001). Following multivariate analysis respective hazard ratios were 1.8, 2.1, 2.4, 3.2, and 3.6 (p<.001). Cause of admission did not affect the association between glucose levels and mortality.
Conclusions: In hospitalized patients, hypoglycemia, either with insulin or spontaneous, is associated with increased short- and long-term mortality.
Context: Hypoglycemia is common among hospitalized patients with and without diabetes mellitus (DM) but the prognostic implications may differ with spontaneous versus insulin-related hypoglycemia.
Objective: Investigate the association between spontaneous or insulin-related hypoglycemia and mortality in hospitalized patients.
Design: Hypoglycemia was defined as blood glucose <70mg/dl (3.9 mmol/l), including moderate hypoglycemia (40-70mg/dl, 2.2-3.9 mmol/l) and severe hypoglycemia (<40mg/dl, 2.2 mmol/l). Use of insulin during hospitalization defined insulin-related hypoglycemia, thus patients were classified into 6 groups: non-insulin treated (NITC) and insulin-treated controls (ITC), insulin-related hypoglycemia (IH) or severe hypoglycemia (ISH), and non insulin-related hypoglycemia (NIH) and severe hypoglycemia (NISH).
Setting: Historical prospectively data of patients hospitalized to medical wards for any-cause between January 2011 and December 2013.
Patients: Patients ≥18 years.
Main outcome: All-cause mortality at the end of follow-up.
Results: Cohort included 33,675 patients. 2,947 had at least one glucose value <70 mg/dl (3.9 mmol/l) (9%), including 2,605 with moderate hypoglycemia (IH=1,011, NIH=1,594) and 342 with severe hypoglycemia (ISH=201, NISH=141). Overall end of follow-up mortality was 31.9% (NITC=28.0%, ITC=42.9%, NIH=50.7%, IH=55.3%, NISH=70.9%, ISH=69.1%). Compared with non-insulin treated controls, unadjusted hazard ratios (95% CI) for mortality were as follows: ITC, 1.7 (1.6-1.8), NIH, 2.2 (2.0-2.4), IH, 2.5 (2.2-2.7), NISH, 4.2 (3.5-5.2), and ISH, 3.8 (3.2-4.5) (p<.001). Following multivariate analysis respective hazard ratios were 1.8, 2.1, 2.4, 3.2, and 3.6 (p<.001). Cause of admission did not affect the association between glucose levels and mortality.
Conclusions: In hospitalized patients, hypoglycemia, either with insulin or spontaneous, is associated with increased short- and long-term mortality.
