Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward.
OBJECTIVE
Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. It is not known whether the same risks exist for diabetic patients who are less severely ill. In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward.


METHODS
This retrospective cohort study analyzed 4,368 admissions of 2,582 patients with diabetes hospitalized in the general ward of a teaching hospital between January 2003 and August 2004. The associations between the number and severity of hypoglycemic (<or=50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated.


RESULTS
Hypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). LOS increased by 2.5 days for each day with hypoglycemia (P < 0.0001).


CONCLUSIONS
Hypoglycemia is common in diabetic patients hospitalized in the general ward. Patients with hypoglycemia have increased LOS and higher mortality both during and after admission. Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population.
Turchin
Alexander
A
Brigham and Women's Hospital, Boston, Massachusetts, USA. aturchin@partners.org
Matheny
Michael E
ME
Shubina
Maria
M
Scanlon
James V
JV
Greenwood
Bonnie
B
Pendergrass
Merri L
ML
D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010362:Patients' Rooms; D012189:Retrospective Studies
D007004:Hypoglycemic Agents; D007328:Insulin