title: Identifying risk factors for severe hypoglycemia in hospitalized patients with diabetes.
abstract: OBJECTIVE
  Some of the deleterious effects of hypoglycemia in hospitalized patients include increased rates of mortality and longer length of stay. Our primary objective was to identify the risk factors associated with severe hypoglycemia to identify those patients at highest risk.
  
  
  METHODS
  The medical records of 5,026 patients with diabetes mellitus (DM) admitted in 2010 were reviewed to identify those patients that developed severe hypoglycemia (blood glucose [BG] <40 mg/dL). We performed χ2 tests to assess statistical significance. Adjusted logical regression was used to determine the risk factors for hypoglycemia in the hospital.
  
  
  RESULTS
  Out of 5,026 DM patients included in our review, 81 experienced severe hypoglycemia (1.6%). Statistically higher proportions of chronic kidney disease (CKD; 69.1% vs. 46.9%, P<.001), congestive heart failure (CHF; 48.1% vs. 28.5%, P<.001), sepsis (49.4% vs. 12.5%, P<.001), insulin use (45.7% vs. 26.04%, P = .000), type 1 DM (21% vs. 5.1%, P = .000), and cirrhosis (14.8% vs. 7.2%, P = .009) were seen in the severe hypoglycemic group compared to the nonsevere hypoglycemic group. Overall, 84% of patients who experienced an episode of severe hypoglycemia in the hospital (BG <40 mg/dL) had a previous episode of hypoglycemia (BG <70 mg/dL). The odds ratios (ORs) for type 1 DM, sepsis, previous hypoglycemia, and insulin use were 3.43 (95% confidence interval [CI] 1.81, 6.49), 2.64 (95% CI 1.6, 4.35), 46.1 (95% CI 24.76, 85.74), and 1.66 (95% CI 1.02, 2.69), respectively.
  
  
  CONCLUSIONS
  Prior episodes of hypoglycemia in the hospital, the presence of type 1 DM, insulin use, and sepsis were identified as independent risk factors for the development of severe hypoglycemia in the hospital.
authors.affiliation: Department of Internal Medicine, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Jared A
authors.initials: JA
authors.lastname: Dendy
authors.affiliation: Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Vijayaratna
authors.initials: V
authors.lastname: Chockalingam
authors.affiliation: Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Naga N
authors.initials: NN
authors.lastname: Tirumalasetty
authors.affiliation: Department of Biostatistics, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Adriana
authors.initials: A
authors.lastname: Dornelles
authors.affiliation: Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Blonde
authors.affiliation: Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Bolton
authors.affiliation: Department of Hospital Medicine, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Meadows
authors.affiliation: Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Andrews