Hypoglycaemia in patients hospitalized at internal department: prevalence and most frequent causes of its development
Authors:
Matej Samoš; Peter Galajda; Michal Mokáň; Matej Stančík; Marián Mokáň
Authors‘ workplace:
I. interná klinika Jesseniovej LF UK a UNM, Martin
Published in:
Forum Diab 2014; 3(1): 34-39
Category:
Main Theme: Original Paper
Overview
Hypoglycaemia is a severe and potentionally life – threatening event. Repeated hypoglycaemia is connected with higher cardiovascular mortality and may lead to cognitive and neurological damage. The prevalence of hypoglycaemia in hospitalized patients remains unclear. The aim of the study was to determine the prevalence of hypoglycaemia, its most frequent causes and risk factors of its development in patients hospitalized at internal department. 4-year retrospective study in patients hospitalized at internal wards of 1st Department of Internal Medicine JFM CU. Hypoglycaemia was defined as blood glucose level ≤ 3.0 mmol/l. Each case of hypoglycaemia from totally 17 872 hospitalizations in followed period was identified. The study monitored number of hypoglycaemic events, symptoms, probable causes, presence and type of diabetes mellitus (DM), its treatment, duration, compensation, insulin administration and presence of other diseases connected with risk of hypoglycaemia. Hypoglycaemia occurred in 558 hospitalizations (3.12 %), 1092 hypoglycaemic events were totally found. 214 patients had repeated hypoglycaemia during hospitalization. In 108 cases hypoglycaemia developed in nondiabetic patients, in 81 cases in patients with type 1 DM, in 358 cases in patients with type 2 DM and in 11 cases in patients with other types of DM. 84 % of patients were on insulin therapy, in 50.8 % of cases intensive insulin therapy was used. Insulin administration, intensive insulin therapy, tumours, kidney diseases and liver diseases were identified as most frequent probable causes of hypoglycaemia development. Hypoglycaemia is a relatively frequent event in hospitalized patients with a prevalence of 3.12 %. In patients with DM is its development mostly connected with antidiabetic therapy, whether in nondiabetic patients tumours, kidney and liver diseases play major role. Results of this study point on the necessity of glucose level monitoring not only in patients with DM, but also in patients with other diseases affecting glucose and insulin metabolism.
Key words:
diabetes mellitus – hypoglycaemia – nondiabetic reasons of hypoglycaemia –prevalence
Sources
1. Zoungas S, Patel A, Chalmers J et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010; 363(15): 1410–1418.
2. Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care 2011; 34(Suppl 2): S132-S137.
3. Svensson AM, McGuire DK, Abrahamsson P et al. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J 2005; 26(13): 1255–1261.
4. Samoš M, Kalinová S, Galajda P et al. Hypoglykémia u hospitalizovaných pacientov bez diabetes mellitus. Diabetes a obezita 2012; 12: 93–97.
5. Davis TM, Brown SG, Jacobs IG et al. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle diabetes study. J Clin Endocrinol Metab 2010; 95(5): 2240–2247.
6. Hart SP, Frier BM. Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission. QJM 1998; 91(7): 505–510.
7. Cryer PE. Hypoglycaemia, functional brain failure and brain death. J Clin Invest 2007; 117(4): 868–870.
8. Warren RE, Frier BM. Hypoglycaemia and cognitive function. Diabetes Obes Metab 2005; 7(5): 493–503.
9. Umpierrez GE, Hor T, Smiley D et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab 2009; 94(2): 564–569.
10. Turchin A, Matheny ME, Shubina M et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 2009; 32(7): 1153–1157.
11. Elliott MB, Schafers SJ, McGill JB et al. Prediction and prevention of treatment-related inpatient hypoglycemia. J Diabetes Sci Technol 2012; 6(2): 302–309.
12. Patel A, MacMahon S, Chalmers J et al (ADVANCE Collaborative Group). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560–2572.
13. Finfer S, Chittock DR, Su SY et al (NICE-SUGAR Study Investigators). Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360(13): 1283–1297.
14. Brunkhorst FM, Engel C, Bloos F et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008; 358(2): 125–139.
15. Preiser JC, Devos P, Ruiz-Santana S et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med 2009; 35(10): 1738–1748.
16. Umpierrez GE, Smiley D, Jacobs S et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 2011; 34(2): 256–261.
17. Varghese P, Gleason V, Sorokin R et al. Hypoglycemia in hospitalized patients treated with antihyperglycemic agents. J Hosp Med 2007; 2(4): 234–240.
18. Cook CB, Kongable GL, Potter DJ et al. Inpatient glucose control: a glycemic survey of 126 U.S. hospitals. J Hosp Med 2009; 4(9): E7-E14. Dostupné z DOI: <http://doi: 10.1002/jhm.533>.
19. Gerstein HC,Miller ME, Byington RP et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545–2559.
20. Davis TM, Brown SG, Jacobs IG et al. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle diabetes study. J Clin Endocrinol Metab 2010; 95(5): 2240–2247.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2014 Issue 1
Most read in this issue
- Acute complications of diabetes mellitus – incidence in patients in intensive care units and case report
- Hypoglycaemia in non-beta-cells tumours
- Hypoglycaemia as cardiovascular risk factor
-
Treatment of type 2 diabetes: How low do you go?
Treat early, treat safely!