دانلود رایگان مقاله انگلیسی پیش بینی های هیپوگلیسمی در بیماران بستری مبتلا به دیابت نوع 2 - اشپرینگر 2018

Abstract

Hypoglycemia is common among hospitalized patients with diabetes mellitus (DM), and is associated with increased morbidity and mortality. Identify pre-admission risk factors associated with in-hospital hypoglycemia. Historical prospectively collected data of adult DM patients hospitalized to medical wards between 2011 and 2013. Hypoglycemia and serious hypoglycemia were defned as at least one blood glucose measurement ≤ 70 and < 54 mg/dl, respectively, during hospitalization. The primary outcome was in-hospital hypoglycemia. The cohort included 5301 patients (mean age 73 ± 13 years, 51% male), including 792 patients (15%) with hypoglycemia, among them 392 patients (7%) with serious hypoglycemia. Patients with hypoglycemia or serious hypoglycemia during hospitalization were older, compared to patients without hypoglycemia and more likely to have chronic renal failure and cerebrovascular disease. Malignancy and female gender were risk factors for hypoglycemia, but not for serious hypoglycemia, while congestive heart failure was associated with increased risk only for serious hypoglycemia. Diabetes mellitus’ duration over 10 years was associated with an almost threefold increased risk for hypoglycemia, compared to DM duration less than a year. Insulin treatment and glycated hemoglobin > 9% were also more common in patients with hypoglycemia. Insulin treatment was associated with a fourfold increase in the risk for hypoglycemia among all glycated hemoglobin categories. Our results identifed several risk factors for in-hospital hypoglycemia in patients with DM. These fndings may lead to appropriate monitoring and early intervention to prevent hypoglycemia and to reduce morbidity and mortality associated with in-hospital hypoglycemia.

Discussion

Hypoglycemia is a major complication in the treatment of patients with DM, and hospitalization is associated with an increased risk for this common event. Following our recent study demonstrating increased mortality rate in patients with in-hospital hypoglycemia [8], in this study we aim to identify pre-admission risk factors and predictors of in-hospital hypoglycemia.

While previous studies report varying rates of hypoglycemia [1–9], mainly due to diferences in patients characteristics and in the defnition of hypoglycemia, our study is based on the recent American Diabetes Association guidelines’ defnitions of hypoglycemia (≤ 70 mg/dl) and serious, clinically signifcant hypoglycemia (< 54 mg/dl) [11]. We have completed a separate analysis of the risk for hypoglycemia and for serious hypoglycemia. Globally, 15% of the patients in our cohort experienced hypoglycemia, and 7% experienced serious hypoglycemia.

Our results identify several risk factors for in-hospital hypoglycemia and serious, hypoglycemia in patients with DM. These include age, BMI, chronic renal failure, cerebrovascular disease, duration of diabetes, glycated hemoglobin in the year prior to admission and insulin treatment. Malignancy and female gender are identifed as risk factors for hypoglycemia, but not for serious hypoglycemia, while congestive heart failure is associated with increased risk only for serious hypoglycemia. While this is not the frst study to identify predictors of hypoglycemia in hospitalized patients [ 2 – 4], our study is novel in that it was based on the new hypoglycemia defnitions by the American Diabetes Association, and investigated separately the predictors for hypoglycemia (≤ 70 mg/dl) and serious, clinically signif - cant hypoglycemia (< 54 mg/dl). Furthermore, as our data indicates, a signifcant interaction between hypoglycemia, glycated hemoglobin and the type of treatment for DM, we analyzed the data according to these variables. As there is a clear diference in the risk for hypoglycemia in patients with well-controlled DM without drug treatment, compared to patients with well-controlled DM using insulin treatment, this analysis has important clinical implications.