Prevention and Management of Insulin-Associated Hypoglycemia in Hospitalized Patients |
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| Affiliation: | 1. From the Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland;3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.;1. From the Division of Hospital Medicine, Department of Medicine, University of California, San Diego, San Diego, California.;2. Center for Innovation and Improvement Science, University of California, San Diego, San Diego, California.;3. Division of Endocrinology, Department of Medicine, University of California, San Diego, San Diego, California.;4. Department of Nursing Education, Development & Research, University of California, San Diego, San Diego, California.;1. From the IU School of Medicine, Department of Medicine, Inpatient Medicine, Indiana University Health Physicians, Indianapolis, Indiana;2. Methodist Research Institute, Indiana University Health, IU School of Medicine, Department of Medicine, Indianapolis, Indiana. |
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| Abstract: | Objective: To determine whether appropriate therapeutic changes in insulin doses are made to prevent and manage insulin-associated hypoglycemic events in non–critically ill hospitalized patients.Methods: This retrospective study was conducted in hospitalized adults on medical or surgical floors with insulin-associated hypoglycemia, excluding treatment with insulin infusions, insulin pumps, and parenteral nutrition. The first hypoglycemic event after 48 hours of admission was the index event. Over the 1-year study period, a total of 457 insulin-associated hypoglycemic events were included as index events.Results: An indication for an insulin dose adjustment was identified in 32 and 42% of patients on day -2 and day -1, respectively, before the index hypoglycemic event, of which 35 and 55%, respectively, had an insulin dose reduction ≥10%. Following the hypoglycemic event, 44% of patients had an insulin dose reduction of ≥20%. Therapeutic reduction of the total daily insulin dose by ≥20% was associated with increased odds of normoglycemia and lower odds of hyperglycemia but was not associated with lower odds of recurrent hypoglycemia on the day following the index hypoglycemic event. There was a high prevalence of hypoglycemic risk factors in this population, with kidney disease and nil per os status being the most prevalent contributing factors.Conclusion: Adherence to the current practice recommendation to reduce insulin doses in patients with borderline hypoglycemia and following overt hypoglycemia was modest. Further studies are needed to understand the associated risks and to define appropriate therapeutic changes for insulin treated patients with borderline and overt hypoglycemia.Abbreviations:AKI = acute kidney injuryBG = blood glucoseCKD = chronic kidney diseaseESRD = end-stage renal diseaseICU = intensive care unitNPH = Neutral Protamine HagedornNPO = nil per osOR = odds ratioTDD = total daily dose |
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