Risk factors for hypoglycemia in patients with type 2 diabetes, hospitalized in internal medicine wards: Findings from the FADOI-DIAMOND study

• Published in: Diabetes research and clinical practice 2016-05, Vol.115, p.24-30
• Main Authors: Borzì, V, Frasson, S, Gussoni, G, Di Lillo, M, Gerloni, R, Augello, G, Gulli, G, Ceriello, A, Solerte, B, Bonizzoni, E, Fontanella, A
• Format: Article
• Language: English
• Subjects: Aged; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Endocrinology & Metabolism; Female; Hospital Mortality; Humans; Hypoglycemia; Hypoglycemia - blood; Hypoglycemia - etiology; Hypoglycemia - mortality; Hypoglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Incidence; Insulin; Insulin - blood; Insulin - therapeutic use; Internal Medicine; Length of hospitalization; Length of Stay; Male; Middle Aged; Risk Factors; Sulfonylurea Compounds - therapeutic use
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2016.01.020

Abstract Aims Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. Methods We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM ( n = 3167), including information about hypoglycemia during hospital stay. The association between occurrence of hypoglycemia and potential predictors was evaluated by means of a multivariable logistic regression analysis. Results A total of 385 symptomatic hypoglycemic events were observed (rate = 12%). Advanced age, cognitive dysfunction, and nephropathy were associated with hypoglycemia. Hypoglycemia occurred in 19.4% of patients treated according to the insulin sliding-scale method versus 11.4% of patients treated with basal bolus ( p < 0.01). More patients with hypoglycemia received sulfonylureas versus the no-hypoglycemia group (28.3% versus 20.6%, p < 0.001). Significantly longer length of hospital stay and increased in-hospital mortality were found in the group with hypoglycemia compared with the no-hypoglycemia group (12.7 ± 10.9 versus 9.6 ± 6.5 days; 8.8% versus 4.8%, p < 0.01). Conclusions Hypoglycemia in hospitalized patients with diabetes is associated with increased length of hospitalization and in-hospital mortality. Identification of patients at increased risk of hypoglycemia may be important for optimally adapting treatment and patient management.