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. 2018 Dec 18;6(1):e000607.
doi: 10.1136/bmjdrc-2018-000607. eCollection 2018.

Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

Saumeth Cardona #  1 , Patricia C Gomez #  1 , Priyathama Vellanki  1 , Isabel Anzola  1 , Clementina Ramos  1 , Maria A Urrutia  1 , Jeehea Sonya Haw  1 , Maya Fayfman  1 , Heqiong Wang  2 , Rodolfo J Galindo  1 , Francisco J Pasquel  1 , Guillermo E Umpierrez  1
Affiliations

Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

Saumeth Cardona et al. BMJ Open Diabetes Res Care. .

Abstract

Importance: The frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.

Objective: We determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.

Research design and methods: Prospective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.

Results: Among 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4-14) vs 7 days (IQR 5-15), p=0.92)) between groups.

Conclusions: Asymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.

Keywords: complications; glycemic control; hospitalization; inpatient diabetes management.

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Conflict of interest statement

Competing interests: GEU is partly supported by research grants from the Public Health Service (grants UL1 TR002378 from the Clinical and Translational Science Award program and 1P30DK111024-01 from the National Institutes of Health and National Center for Research Resources). PV is supported by NIH grant: 3K12HD085850-03S1. GEU has received unrestricted research support for inpatient studies (to Emory University) from Merck, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Sanofi. FJP and PV have received consulting fees from Boehringer Ingelheim and Merck. RJG has received unrestricted research support for inpatient studies (to Emory University) from Novo Nordisk and consulting fees from Abbott. SC, PCG, IA, CR, MAU, JSH, MF, and HW declared no conflicts of interest.

References

    1. American Diabetes Association 14. Diabetes care in the hospital: standards of medical care in diabetes-2018. Diabetes Care 2018;41:S144–S151. 10.2337/dc18-S014 - DOI - PubMed
    1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. . CONSENSUS statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm - 2018 executive summary. Endocr Pract 2018;24:91–120. 10.4158/CS-2017-0153 - DOI - PubMed
    1. Boucai L, Southern WN, Zonszein J. Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities. Am J Med 2011;124:1028–35. 10.1016/j.amjmed.2011.07.011 - DOI - PMC - PubMed
    1. Farrokhi F, Klindukhova O, Chandra P, et al. . Risk factors for inpatient hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes. J Diabetes Sci Technol 2012;6:1022–9. 10.1177/193229681200600505 - DOI - PMC - PubMed
    1. Krikorian A, Ismail-Beigi F, Moghissi ES. Comparisons of different insulin infusion protocols: a review of recent literature. Curr Opin Clin Nutr Metab Care 2010;13:198–204. 10.1097/MCO.0b013e32833571db - DOI - PubMed

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