Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

OBJECTIVE Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. It is not known whether the same risks exist for diabetic patients who are less severely ill. In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward. RESEARCH DESIGN AND METHODS This retrospective cohort study analyzed 4,368 admissions of 2,582 patients with diabetes hospitalized in the general ward of a teaching hospital between January 2003 and August 2004. The associations between the number and severity of hypoglycemic (≤50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated. RESULTS Hypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). LOS increased by 2.5 days for each day with hypoglycemia (P < 0.0001). CONCLUSIONS Hypoglycemia is common in diabetic patients hospitalized in the general ward. Patients with hypoglycemia have increased LOS and higher mortality both during and after admission. Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population.

• Publication year

  2009

• Venue

  Diabetes Care

• Publication date

  2009-07-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.2337/dc08-2127PMID 19564471PMCID 2699723
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

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• Intensive insulin therapy and pentastarch resuscitation in severe sepsis.

  2008cited by this paper
• Severe hypoglycemia in critically ill patients: Risk factors and outcomes*

  2007cited by this paper
• Intensive insulin therapy in the medical ICU.

  2006cited by this paper
• American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control

  2006cited by this paper
• Intensive Insulin Therapy in Mixed Medical/Surgical Intensive Care Units

  2006cited by this paper
• American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control.

  2006cited by this paper
• "Glucometrics"—Assessing the Quality of Inpatient Glucose Management

  2006cited by this paper
• Predisposing factors for hypoglycemia in the intensive care unit*

  2006influential reference
• Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction: Implications for Patients With and Without Recognized Diabetes

  2005cited by this paper
• Identification of patients with diabetes from the text of physician notes in the electronic medical record.

  2005cited by this paper
• Hypoglycemic Brain Damage

  2004cited by this paper
• Hypoglycemia as a predictor of mortality in hospitalized elderly patients.

  2003cited by this paper
• Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

  2003cited by this paper
• Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

  2002cited by this paper
• Nurse-Staffing Levels and the Quality of Care in Hospitals

  2002cited by this paper
• Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview

  2001cited by this paper
• Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview.

  2000cited by this paper
• A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation

  1999cited by this paper
• Protein-energy undernutrition among elderly hospitalized patients: a prospective study.

  1999cited by this paper
• Hypoglycemia in Hospitalized Nondiabetic Older Patients

  1998cited by this paper
• Mortality in hospitalized patients with hypoglycemia and severe hyperglycemia.

  1995cited by this paper
• Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.

  1992cited by this paper
• An improved Bonferroni procedure for multiple tests of significance

  1986cited by this paper
• Hypoglycemia in hospitalized patients. Causes and outcomes.

  1986cited by this paper
• Printed in Great Britain

  1970cited by this paper
• GLYCOLYSIS IN LEUCEMIC BLOOD

  1927cited by this paper

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  2026cites this paper
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  2026cites this paper
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  2026cites this paper
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  2026cites this paper
• Awareness Level of Diabetes Mellitus Patients About Hypoglycemia Attacks and Management in Cluster 1, Riyadh, Saudi Arabia

  2026cites this paper
• Blood glucose management in hospitalized patients: a review of current literature

  2025cites this paper
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  2025influential citation
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  2025cites this paper
• Effect of Hypoglycemia on QT Interval in Individuals with and without Type 2 Diabetes: A Randomized Crossover Trial.

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• Accuracy of continuous glucose monitoring in critically ill patients

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• Machine learning–based prediction model for hypoglycemia during hospitalization in T2DM patients

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• A review of the effect of SGLT2 inhibitors on clinical and glycemic outcomes in hospitalized patients: data from studies that included patients with diabetes.

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• A Real-World Study of Oral Anti-Hyperglycemic Agents as Compared to Basal Insulin in Hospitalized Patients with Type 2 Diabetes.

  2025cites this paper
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  2025cites this paper
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  2024cites this paper
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  2024cites this paper
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  2024cites this paper
• The Canadian Hypoglycaemia During Hospitalisation (HyDHo) Score is Externally Valid in the Australian DINGO Cohort of Adults with Diabetes.

  2024cites this paper
• Glycemic Management in Insulin-Naive Patients in the Inpatient Setting.

  2024cites this paper
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  2024cites this paper
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  2024cites this paper
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  2024cites this paper
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  2024cites this paper
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  2024cites this paper
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  2022cites this paper
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  2022cites this paper
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• GLP‐1 receptor agonist use during hospitalisation: Better glycaemic control compared to premixed insulin

  2022cites this paper
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  2022cites this paper
• Hospital Diabetes Meeting 2022

  2022cites this paper
• Evaluation of the Efficacy of a Hypoglycemia Protocol to Treat Severe Hypoglycemia

  2022cites this paper
• Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline.

  2022cites this paper
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• Intensive versus conservative glycemic control in patients undergoing coronary artery bypass graft surgery: A protocol for systematic review of randomised controlled trials

  2022cites this paper
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