title: Risk factors for hypoglycemia in patients with type 2 diabetes, hospitalized in internal medicine wards: Findings from the FADOI-DIAMOND study.
abstract: OBJECTIVE
  Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs.
  
  
  METHODS
  We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay. The association between occurrence of hypoglycemia and potential predictors was evaluated by means of a multivariable logistic regression analysis.
  
  
  RESULTS
  A total of 385 symptomatic hypoglycemic events were observed (rate=12%). Advanced age, cognitive dysfunction, and nephropathy were associated with hypoglycemia. Hypoglycemia occurred in 19.4% of patients treated according to the insulin sliding-scale method versus 11.4% of patients treated with basal bolus (p<0.01). More patients with hypoglycemia received sulfonylureas versus the no-hypoglycemia group (28.3% versus 20.6%, p<0.001). Significantly longer length of hospital stay and increased in-hospital mortality were found in the group with hypoglycemia compared with the no-hypoglycemia group (12.7±10.9 versus 9.6±6.5 days; 8.8% versus 4.8%, p<0.01).
  
  
  CONCLUSIONS
  Hypoglycemia in hospitalized patients with diabetes is associated with increased length of hospitalization and in-hospital mortality. Identification of patients at increased risk of hypoglycemia may be important for optimally adapting treatment and patient management.
authors.affiliation: Department of Internal Medicine, Hospital "Policlinico Vittorio Emanuele", Catania, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Borzì
authors.affiliation: Clinical Research Department, FADOI Foundation, Milan, Italy. Electronic address: stefania.frasson@fadoi.org.
authors.forename: S
authors.initials: S
authors.lastname: Frasson
authors.affiliation: Clinical Research Department, FADOI Foundation, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gussoni
authors.affiliation: Department of Emergency, Azienda Ospedali Marche Nord Santa Croce di Fano, Pesaro e Urbino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Lillo
authors.affiliation: Department of Internal Medicine, Ospedali Riuniti di Trieste University Hospital, Trieste, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gerloni
authors.affiliation: Department of Internal Medicine, Barone Lombardo Hospital, Canicattì, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Augello
authors.affiliation: Department of Internal Medicine, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gulli
authors.affiliation: Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ceriello
authors.affiliation: Department of Internal Medicine, University Hospital of Pavia, Pavia, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Solerte
authors.affiliation: Section of Medical Statistics and Biometry GA Maccacaro, Department of Clinical Science and Community, University of Milan, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Bonizzoni
authors.affiliation: Department of Internal Medicine, Fatebenefratelli Hospital, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fontanella
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
keywords: Hypoglycemia; Insulin; Internal medicine; Length of hospitalization; Risk factors