Economic and clinical impact of inpatient diabetic hypoglycemia.
OBJECTIVE
To assess the clinical and economic impact of hypoglycemia that develops during hospitalization of patients with diabetes.


METHODS
In this retrospective cohort study, data from 70 hospitals were used to identify the first inpatient encounter for adult patients with diabetes. Patients were included if all blood glucose measurements were 70 mg/dL or higher during the first 24 hours and their primary discharge diagnosis was for a condition other than hypoglycemia. Those who developed laboratory evidence of hypoglycemia (blood glucose <70 mg/dL after 24 hours) were compared with patients whose blood glucose values were all 70 mg/dL or higher. An alternative definition of hypoglycemia (blood glucose <50 mg/dL after 24 hours) was also evaluated. We adjusted for potential confounders with multivariate models.


RESULTS
Hypoglycemia had an adverse effect on all outcomes among more than 100,000 diabetic patients. After adjustment, patients with diabetes who developed hypoglycemia had higher charges (38.9%), longer lengths of stay (3.0 days), higher mortality (odds ratio, 1.07; 95% confidence interval, 1.02-1.11), and higher odds of being discharged to a skilled nursing facility (odds ratio, 1.58; 95% confidence interval, 1.48-1.69) than diabetic patients without hypoglycemia (P<.01 for all). In all cases, using the lower threshold (<50 mg/dL) to define hypoglycemia resulted in similar findings with a larger magnitude of differences.


CONCLUSIONS
Although a direct causal relationship cannot be inferred, these study findings suggest the importance of carefully maintaining euglycemia during hospitalizations. Whether the observed worse outcomes were due to hypoglycemia itself or whether they were a marker of worse outcomes due to other causes requires further research.
Curkendall
Suellen M
SM
Cerner LifeSciences, Beverly Hills, California 90212, USA.
Natoli
Jaime L
JL
Alexander
Charles M
CM
Nathanson
Brian H
BH
Haidar
Tracy
T
Dubois
Robert W
RW
D000368:Aged; D048909:Diabetes Complications / Q000191:economics* / Q000401:mortality / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000191:economics / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000209:etiology* / Q000401:mortality; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies