TY - JOUR
T1 - The clinical impact of inpatient hypoglycemia
AU - Brutsaert, Erika
AU - Carey, Michelle
AU - Zonszein, Joel
N1 - Funding Information:
Disclosures: This article was partially supported by National Institutes of Health P60 Grant DK20541, which supports the Diabetes Research and Training Center of Albert Einstein College of Medicine. E. Brutsaert and M. Carey have no conflicts of interest to report. J. Zonszein serves as a speaker and consultant for the following companies: Novo Nordisk, Takeda Pharmaceuticals North America, Merck/Schering-Plough Pharmaceuticals, Janssen Pharmaceutical, Sanofi-Aventis, Eli Lilly, Boehringer Ingelheim.
PY - 2014
Y1 - 2014
N2 - Hypoglycemia is common in hospitalized patients and is associated with poor outcomes, including increased mortality. Older individuals and those with comorbidities are more likely to suffer the adverse consequences of inpatient hypoglycemia. Observational studies have shown that spontaneous inpatient hypoglycemia is a greater risk factor for death than iatrogenic hypoglycemia, suggesting that hypoglycemia acts as a marker for more severe illness, and may not directly cause death. Initial randomized controlled trials of intensive insulin therapy in intensive care units demonstrated improvements in mortality with tight glycemic control, despite high rates of hypoglycemia. However, follow-up studies have not confirmed these initial findings, and the largest NICE-SUGAR study showed an increase in mortality in the tight control group. Despite these recent findings, a causal link between hypoglycemia and mortality has not been clearly established. Nonetheless, there is potential for harm from inpatient hypoglycemia, so evidence-based strategies to treat hyperglycemia, while preventing hypoglycemia should be instituted, in accordance with current practice guidelines.
AB - Hypoglycemia is common in hospitalized patients and is associated with poor outcomes, including increased mortality. Older individuals and those with comorbidities are more likely to suffer the adverse consequences of inpatient hypoglycemia. Observational studies have shown that spontaneous inpatient hypoglycemia is a greater risk factor for death than iatrogenic hypoglycemia, suggesting that hypoglycemia acts as a marker for more severe illness, and may not directly cause death. Initial randomized controlled trials of intensive insulin therapy in intensive care units demonstrated improvements in mortality with tight glycemic control, despite high rates of hypoglycemia. However, follow-up studies have not confirmed these initial findings, and the largest NICE-SUGAR study showed an increase in mortality in the tight control group. Despite these recent findings, a causal link between hypoglycemia and mortality has not been clearly established. Nonetheless, there is potential for harm from inpatient hypoglycemia, so evidence-based strategies to treat hyperglycemia, while preventing hypoglycemia should be instituted, in accordance with current practice guidelines.
KW - Hospital
KW - Hypoglycemia
KW - Inpatient
KW - Intensive insulin therapy
KW - Mortality
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U2 - 10.1016/j.jdiacomp.2014.03.002
DO - 10.1016/j.jdiacomp.2014.03.002
M3 - Review article
C2 - 24685363
AN - SCOPUS:84903301001
SN - 1056-8727
VL - 28
SP - 565
EP - 572
JO - Journal of Diabetes and Its Complications
JF - Journal of Diabetes and Its Complications
IS - 4
ER -