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. 2024 Apr 10;16(1):83.
doi: 10.1186/s13098-024-01329-5.

Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality

Tomás González-Vidal  1   2 , Carmen Lambert  3 , Ana Victoria García  3 , Elsa Villa-Fernández  3 , Pedro Pujante  4   3 , Jessica Ares-Blanco  4   3   5 , Edelmiro Menéndez Torre #  4   3   5   6 , Elías Delgado-Álvarez #  4   3   5   6
Affiliations

Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality

Tomás González-Vidal et al. Diabetol Metab Syndr. .

Abstract

Background: Previous research has indicated that hypoglycemia during hospitalization is a predictor of unfavorable outcomes in patients with diabetes. However, no studies have examined the long-term impact of hypoglycemia in adults admitted for hyperglycemic crises. The study was aimed to investigate the long-term implications of hypoglycemia during hyperosmolar hyperglycemic crises, particularly in terms of all-cause mortality.

Methods: This retrospective cohort study included 170 patients (82 men [48.2%], median age 72 years) admitted to a university hospital for hyperosmolar hyperglycemic crises, including pure hyperosmolar hyperglycemic states and hyperosmolar diabetic ketoacidoses. We separately investigated the prognostic significance of hypoglycemia on mortality during the initial intravenous insulin therapy phase and during the later subcutaneous insulin therapy phase, both during hospitalization and in the long term (median follow-up, 652 days; range 2-3460 days).

Results: Both hypoglycemia during the initial intravenous insulin therapy phase (observed in 26.5% of patients) and hypoglycemia during the later subcutaneous insulin therapy phase (observed in 52.7% of patients) were associated with long-term mortality. After adjusting for potential confounders, hypoglycemia during the initial intravenous insulin therapy phase remained associated with mortality (hazard ratio 2.10, 95% CI 1.27-3.46, p = 0.004).

Conclusions: Hypoglycemia during hyperosmolar hyperglycemic crises is a marker of long-term mortality, especially when it occurs during the initial intravenous insulin therapy phase.

Keywords: Diabetic ketoacidosis; Hyperosmolar hyperglycemic state; Hypoglycemia; Mortality.

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Conflict of interest statement

The authors declare no competing interests for the present study.

Figures

Fig. 1
Fig. 1
Probability of survival (Kaplan–Meier curves) in patients stratified according to the various forms of hypoglycemia during hospitalization for hyperosmolar hyperglycemic crises. Vertical ticks represent censored data. P-values were calculated with the log-rank test
See this image and copyright information in PMC

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