Temporal and geographic patterns of hypoglycemia among hospitalized patients with diabetes mellitus.
BACKGROUND
Hypoglycemia is often cited as a barrier to achieving inpatient glycemic targets. We sought to characterize hypoglycemic events in our institution by work-shift cycle and by specific treatment area.


METHODS
Capillary (bedside) and blood (laboratory) glucose values of <70 mg/dl for patients with either a known diagnosis of diabetes or with evidence of hyperglycemia were abstracted from our laboratory database for hospitalizations between October 1, 2007, and February 3, 2008. Hypoglycemic events were analyzed by 12 h nursing work-shift cycles (day shift, 07:00 to 18:59; night shift, 19:00 to 06:59) and by the six medical, surgical, and intensive care areas in the hospital (designated areas 1 to 6).


RESULTS
We identified 206 individual patients with either diabetes or hyperglycemia (mean age, 67 years; 56% men; 83% white) who had 423 hypoglycemic events. There were 78% more hypoglycemic events during the night shift (n = 271 events in 128 individual patients) than during the day shift (n = 152 events in 96 individual patients). Most of the night-shift hypoglycemic measurements were detected between 04:00 and 04:59 or 06:00 and 06:59. The mean hypoglycemic level was comparable between shifts (p = .79) and across the six inpatient areas. The number of hypoglycemic events per person increased with lengths of hospital stay >5 days. The prevalence of hypoglycemia varied across patient care areas within the hospital, with most (28%) detected in one area of the hospital.


CONCLUSIONS
There are temporal and geographic patterns in the occurrence of hypoglycemia among patients with diabetes or hyperglycemia in our hospital. Further study should focus on the reasons underlying these variations so that specific interventions can address the risk of hypoglycemia during peak times and places.
Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Rachel M
RM
Bailon
Curtiss B
CB
Cook
Michael J
MJ
Hovan
Bryan P
BP
Hull
Karen M
KM
Seifert
Victoria
V
Miller-Cage
Karen A
KA
Beer
Mary E
ME
Boyle
Stephanie D
SD
Littman
Janice M
JM
Magallanez
Joanne M
JM
Fischenich
Jana K
JK
Harris
Susie S
SS
Scoggins
Josephine
J
Uy
D000368:Aged; D001130:Arizona / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D002940:Circadian Rhythm; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents