Impact of glycemic variability and hypoglycemia on adverse hospital outcomes in non-critically ill patients.
OBJECTIVE
To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia.


METHODS
A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF).


RESULTS
There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2 ± 11.1. Hypoglycemia (POCG ≤70 mg/dl [3.9 mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p=0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p=0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p=<0.001] and an increase of 2 days in LOS for those with average %CV.


CONCLUSIONS
Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.
Section of Endocrinology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
Yoojin
Y
Kim
Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
Kumar B
KB
Rajan
Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA.
Shannon A
SA
Sims
Department of Health Studies, University of Chicago, Chicago, IL, USA.
Kristen E
KE
Wroblewski
Section of Endocrinology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA; Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sreutrakul@yahoo.com.
Sirimon
S
Reutrakul
D058186:Acute Kidney Injury / Q000209:etiology; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000150:complications*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Glycemic variability; Hospitalization outcomes; Hypoglycemia; Length of stay; Non-critically ill