Hospital Management of Diabetes (G Umpierrez, Section Editor)

Current Diabetes Reports

, Volume 13, Issue 1, pp 107-113

Impact of Hypoglycemia in Hospitalized Patients

  • Michelle CareyAffiliated withDepartment of Medicine, Division of Endocrinology and Metabolism, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine Email author 
  • , Laura BoucaiAffiliated withDepartment of Medicine, Division of Endocrinology and Metabolism, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine
  • , Joel ZonszeinAffiliated withDepartment of Medicine, Division of Endocrinology and Metabolism, Clinical Diabetes Center, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine

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Abstract

Hypoglycemia is a common problem in hospitalized patients, particularly the elderly, frail, and severely ill. Hypoglycemia has been implicated in the development of adverse clinical outcomes, including increased mortality. Fear of iatrogenic hypoglycemia remains an obstacle to adequate inpatient glycemic control. However, evidence from large clinical trials is mixed: several intensive care unit studies have shown either reduced or no change in mortality with intensive glycemic control, despite high rates of iatrogenic hypoglycemia, and only 1 large study showed higher mortality. In the general ward setting, the association of hypoglycemia with worse outcomes and mortality has been frequently reported, but after multivariate adjustment for comorbidities this association disappears. Spontaneous hypoglycemia, rather than iatrogenic hypoglycemia, is strongly associated with mortality suggesting that hypoglycemia behaves as a biomarker rather than a causative factor of adverse outcomes. Inpatient glycemic management should be patient-centered, follow the current guidelines, and aimed at preventing hypoglycemia.

Keywords

Hypoglycemia Mortality Inpatient Diabetes Hospital