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Mortality in hospitalized patients with hypoglycemia and severe hyperglycemia
A Stagnaro-Green1, M K Barton, P L Linekin
1Department of Nursing (PLL, EC), Mount Sinai School of Medicine, New York, NY 10029, USA.
Insights
Hypoglycemia and severe hyperglycemia are common in hospitalized patients, significantly increasing mortality risk, especially for minority groups. Early detection and treatment are crucial for better outcomes.
Area of Science:
- Internal Medicine
- Endocrinology
- Hospital Medicine
Background:
- Investigated the occurrence and consequences of hypoglycemia and severe hyperglycemia in hospitalized patients.
- Defined hypoglycemia as blood glucose <= 2.7 mmol/L and severe hyperglycemia as >= 22.2 mmol/L.
Purpose of the Study:
- To determine the incidence, causes, and implications of hypoglycemia and severe hyperglycemia in an urban tertiary medical center's inpatient population.
- To assess the association between these glycemic extremes and in-hospital mortality.
Main Methods:
- Conducted a 49-day prospective study using daily computer searches of the Laboratory Information System.
- Reviewed patient charts for demographic data, risk factors, and epidemiologic variables.
- Obtained hospitalization outcomes through follow-up.
Main Results:
- Incidence rates were 1.5% for hypoglycemia and 1.9% for hyperglycemia.
- A significant proportion of affected patients (76% hypoglycemic, 16% hyperglycemic) had no prior diabetes history.
- Mortality rates were substantially higher for hypoglycemic (22.2%) and hyperglycemic (11.1%) patients compared to others (2.3%).
- Disparities in mortality were observed among racial groups for hypoglycemia.
Conclusions:
- Hypoglycemia and severe hyperglycemia are frequent in hospitalized patients and indicate heightened in-hospital mortality risk.
- These glycemic disturbances act as metabolic markers for high-risk patients.
- Future research should focus on early identification and aggressive management strategies for at-risk individuals.
Background:
We designed a study to determine the incidence, cause, and implications of hypoglycemia (< or = 2.7 mmol/L, 49 mg/dL) and severe hyperglycemia (> or = 22.2 mmol/L, 400 mg/dL) in in-patients at an urban tertiary medical center.
Methods:
A daily computer search of the Laboratory Information System identified all hospitalized patients with hypoglycemia and severe hyperglycemia during a 49-day period. Chart review was used to assess demographic information, risk factors, and epidemiologic variables. The eventual outcome of the hospitalization was obtained by follow-up.
Results:
The incidence of hypoglycemia was 1.5%, and of hyperglycemia, 1.9%. Seventy-six percent of the hypoglycemic patients and 16% of the hyperglycemic patients had no prior history of diabetes. The mortality rate for hypoglycemic patients was 22.2%; for hyperglycemic patients it was 11.1%. For all other hospitalized patients it was 2.3% (p < 0.0001). Mortality rates for the black and Hispanic patients who were hypoglycemic (30% and 46%) were significantly higher than for white patients (6%, p < 0.01).
Conclusions:
Hypoglycemia and severe hyperglycemia are not uncommon in hospitalized patients and serve as metabolic markers for patients at increased risk for inhospital mortality. Early identification of at-risk patients and the impact of aggressive treatment of their underlying disease processes should be evaluated in future studies.