Hypoglycaemia in hospitalized patients with or without heart failure

Abstract

Hospitalized patients with heart failure (HF) undergoing bedside glucose monitoring with subcutaneous insulin orders were retrospectively identified over 2 years. Hypoglycaemia was defined as any glucose value <3.9 mmol/L (70 mg/dL) within 24 hours of admission (Hypo_1day ) or throughout the hospitalization (Hypo_T ) or any glucose value <2.2 mmol/L (40 mg/dL) throughout the hospitalization (Hypo_Severe ). A total of 13 424 patients were included, of whom 2484 had HF. Patients with HF were more likely to have Hypo_1day (9.1% vs 7.0%, P = .0003), Hypo_T (28% vs 18.5%, P < .0001), or Hypo _Severe (3.4% vs 2.1%, P = .0001). After controlling for other variables, the odds of Hypo_1day were similar between the HF and non-HF groups (odds ratio [OR] 1.14, 95% CI 0.94-1.39, P = .18, fully adjusted model), slightly lower for Hypo_T (OR 0.85, 95% CI 0.73-0.99, P = .03, fully adjusted model), and similar for Hypo_Severe (OR 1.25, 95% CI 0.91-1.70, P = .17). Hypo_1day , Hypo_T and Hypo_Severe were all associated with increased mortality; there was no evidence of an interaction by HF status. Hypoglycaemia occurred at a similar or lower frequency in hospitalized patients with HF compared to those without HF. Hypoglycaemia was associated with increased hospital mortality, regardless of HF status.

Keywords: cardiovascular disease; cohort study; hypoglycaemia.