title: INPATIENT HYPOGLYCEMIC EVENTS IN A COMPARATIVE EFFECTIVENESS TRIAL FOR GLYCEMIC CONTROL IN A HIGH-RISK POPULATION.
abstract: OBJECTIVE
  Inpatient hypoglycemia (glucose ≤70 mg/dL) is a limitation of intensive control with insulin. Causes of hypoglycemia were evaluated in a randomized controlled trial examining intensive glycemic control (IG, target 140 mg/dL) versus moderate glycemic control (MG, target 180 mg/dL) on post-liver transplant outcomes.
  
  
  METHODS
  Hypoglycemic episodes were reviewed by a multidisciplinary team to calculate and identify contributing pathophysiologic and operational factors. A subsequent subgroup case control (1:1) analysis (with/without) hypoglycemia was completed to further delineate factors. A total of 164 participants were enrolled, and 155 patients were examined in depth.
  
  
  RESULTS
  Overall, insulin-related hypoglycemia was experienced in 24 of 82 patients in IG (episodes: 20 drip, 36 subcutaneous [SQ]) and 4 of 82 in MG (episodes: 2 drip, 2 SQ). Most episodes occurred at night (41 of 60), with high insulin amounts (44 of 60), and during a protocol deviation (51 of 60). Compared to those without hypoglycemia (n = 127 vs. n = 28), hypoglycemic patients had significantly longer hospital stays (13.6 ± 12.6 days vs. 7.4 ± 6.1 days; P = .002), higher peak insulin drip rates (17.4 ± 10.3 U/h vs. 13.1 ± 9.9 U/h; P = .044), and higher peak insulin glargine doses (36.8 ± 21.4 U vs. 26.2 ± 24.3 U; P = .035). In the case-matched analysis (24 cases, 24 controls), those with insulin-related hypoglycemia had higher median peak insulin drip rates (17 U/h vs. 11 U/h; P = .04) and protocol deviations (92% vs. 50%; P = .004).
  
  
  CONCLUSIONS
  Peak insulin requirements and protocol deviations were correlated with hypoglycemia.
  
  
  BACKGROUND
  DM = diabetes mellitus ICU = intensive care unit IG = intensive glycemic control MELD = Model for End-stage Liver Disease MG = moderate glycemic control SQ = subcutaneous.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Welsh
authors.forename: Teresa
authors.initials: T
authors.lastname: Derby
authors.forename: Suruchi
authors.initials: S
authors.lastname: Gupta
authors.forename: Candice
authors.initials: C
authors.lastname: Fulkerson
authors.forename: Diana Johnson
authors.initials: DJ
authors.lastname: Oakes
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
authors.forename: J P
authors.initials: JP
authors.lastname: Norvell
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D057186:Comparative Effectiveness Research; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007297:Inpatients; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D007362:Intensive Care Units; D017093:Liver Failure / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin