title: Diurnal temporal patterns of hypoglycaemia in hospitalized people with diabetes may reveal potentially correctable factors.
abstract: OBJECTIVE
  To determine whether diurnal temporal variations in hypoglycaemic frequency occur in hospitalized patients.
  
  
  METHODS
  Hypoglycaemic events were identified in a snapshot bedside audit of capillary blood glucose results from diabetes charts of all inpatients receiving insulin or a sulphonylurea (with or without insulin) on 2 days separated by 6 weeks. Additionally, capillary blood glucose measurements were remotely captured over 2 months, in the same category of patients, and analysed for temporal patterns. Hypoglycaemia was defined as 'severe' when the capillary blood glucose was < 3.0 mmol/l and 'mild' when the capillary blood glucose was between 3.0 and 3.9 mmol/l.
  
  
  RESULTS
  The bedside audit found that 74% of those audited experienced a hypoglycaemia event. Eighty-three per cent of all hypoglycaemic events and 70% of severe events were recorded between 21.00 and 09.00 h. This was confirmed in the longer duration remote monitoring study where 70% of all hypoglycaemic events and 66% of severe events occurred between 21.00 and 09.00 h.
  
  
  CONCLUSIONS
  Hypoglycaemia occurs more frequently between 21.00 and 09.00 h in hospitalized patients receiving treatments that can cause hypoglycaemia. This may be related to insufficient carbohydrate intake during this period, and is potentially preventable by changes in catering practice.
authors.affiliation: The Diabetes Centre, Ipswich Hospital, Ipswich, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kerry
authors.forename: S
authors.initials: S
authors.lastname: Mitchell
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Scott
authors.forename: G
authors.initials: G
authors.lastname: Rayman
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002940:Circadian Rhythm; D003695:Delivery of Health Care / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D012307:Risk Factors; D062410:Snacks; D013997:Time Factors; D006113:United Kingdom
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin