Impact of hypoglycemia in hospitalized patients.
Hypoglycemia is a common problem in hospitalized patients, particularly the elderly, frail, and severely ill. Hypoglycemia has been implicated in the development of adverse clinical outcomes, including increased mortality. Fear of iatrogenic hypoglycemia remains an obstacle to adequate inpatient glycemic control. However, evidence from large clinical trials is mixed: several intensive care unit studies have shown either reduced or no change in mortality with intensive glycemic control, despite high rates of iatrogenic hypoglycemia, and only 1 large study showed higher mortality. In the general ward setting, the association of hypoglycemia with worse outcomes and mortality has been frequently reported, but after multivariate adjustment for comorbidities this association disappears. Spontaneous hypoglycemia, rather than iatrogenic hypoglycemia, is strongly associated with mortality suggesting that hypoglycemia behaves as a biomarker rather than a causative factor of adverse outcomes. Inpatient glycemic management should be patient-centered, follow the current guidelines, and aimed at preventing hypoglycemia.
Department of Medicine, Division of Endocrinology and Metabolism, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine, 1825 Eastchester Road, Bronx, NY 10461, USA, mcarey@montefiore.org
Michelle
M
Carey
Laura
L
Boucai
Joel
J
Zonszein
D001786:Blood Glucose / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D007297:Inpatients; D005791:Patient Care; D012307:Risk Factors
D001786:Blood Glucose