title: Predictors of recurrent hypoglycemia following a severe hypoglycemic event among hospitalized patients.
abstract: OBJECTIVE
  Severe hypoglycemia is associated with poor hospital outcomes, but variables contributing to the adequacy of treatment have not been described. The objective of this study was to determine predictors of recurrent hypoglycemia among hospitalized patients with a severe hypoglycemic event.
  
  
  METHODS
  Patients with severe hypoglycemia (glucose <40 mg/dl) with a concomitant insulin order were identified using the study institution's Information Warehouse. The primary outcome was the prevalence of recurrent hypoglycemia (defined as <70 mg/dl within 24 hours) and to identify independent predictors of recurrent hypoglycemia. Secondary outcomes included time to blood glucose recheck, time to blood glucose ≥ 70 mg/dl, and rebound hyperglycemia (defined as glucose >300 mg/dl within 24 hours). Multivariable linear and logistic regression models were performed.
  
  
  RESULTS
  A total of 129 patients with severe hypoglycemia were identified. The median time to repeat glucose measurement was 29 (IQR 15-61) minutes, while the time to resolution of hypoglycemia was 49 (IQR 26-103) minutes. Recurrent hypoglycemia occurred in 49% of patients, while 19% of patients experienced rebound hyperglycemia. Independent predictors of recurrent hypoglycemia included lower repeat glucose (p = 0.025), low glomerular filtration rate (p = 0.033), and lack of insulin adjustment (p = 0.012). Independent predictors of maximum glucose post-event were type 1 diabetes (p = 0.0003), history of any diabetes (p = 0.013), and total bolus dose of insulin (p < 0.0001). Overnight timing of events was the only predictor of shorter time to hypoglycemia resolution (p < 0.0001).
  
  
  CONCLUSIONS
  Recurrent hypoglycemia following severe hypoglycemia is common in the hospital, suggesting the need for enhanced monitoring in such patients. Further research is needed to identify methods to reduce the incidence of recurrent hypoglycemia.
authors.affiliation: a College of Medicine , The Ohio State University , Columbus , OH , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: D'Netto
authors.affiliation: b Department of Pharmacy , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: Claire V
authors.initials: CV
authors.lastname: Murphy
authors.affiliation: c Department of Clinical Resources , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: Antoinett
authors.initials: A
authors.lastname: Mitchell
authors.affiliation: a College of Medicine , The Ohio State University , Columbus , OH , USA.|d Division of Endocrinology, Diabetes & Metabolism , The Ohio State University , Columbus , OH , USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dungan
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015994:Incidence; D007297:Inpatients; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Hypoglycemia; glucose; hospital; insulin; monitoring