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Current Diabetes Reports
Erschienen in: Current Diabetes Reports 1/2013

01.02.2013 | Hospital Management of Diabetes (G Umpierrez, Section Editor)

Impact of Hypoglycemia in Hospitalized Patients

verfasst von: Michelle Carey, Laura Boucai, Joel Zonszein

Erschienen in: Current Diabetes Reports | Ausgabe 1/2013

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Abstract

Hypoglycemia is a common problem in hospitalized patients, particularly the elderly, frail, and severely ill. Hypoglycemia has been implicated in the development of adverse clinical outcomes, including increased mortality. Fear of iatrogenic hypoglycemia remains an obstacle to adequate inpatient glycemic control. However, evidence from large clinical trials is mixed: several intensive care unit studies have shown either reduced or no change in mortality with intensive glycemic control, despite high rates of iatrogenic hypoglycemia, and only 1 large study showed higher mortality. In the general ward setting, the association of hypoglycemia with worse outcomes and mortality has been frequently reported, but after multivariate adjustment for comorbidities this association disappears. Spontaneous hypoglycemia, rather than iatrogenic hypoglycemia, is strongly associated with mortality suggesting that hypoglycemia behaves as a biomarker rather than a causative factor of adverse outcomes. Inpatient glycemic management should be patient-centered, follow the current guidelines, and aimed at preventing hypoglycemia.
Literatur
1.
•• Umpierrez G, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:16–38. These are the most recent guidelines for management of hyperglycemia in patients on the general wards.PubMedCrossRef
2.
Cook CB, Kongable GL, Potter DJ, et al. Inpatient glucose control: a glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009;4:E7–E14.PubMedCrossRef
3.
Varghese P, Gleason V, Sorokin R, et al. Hypoglycemia in hospitalized patients treated with antihyperglycemic agents. J Hosp Med. 2007;2:234–40.PubMedCrossRef
4.
•• Boucai L, Southern WN, Zonszein J. Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities. Am J Med. 2011;124:1028–35. This large retrospective cohort study showed that spontaneous hypoglycemia, but not iatrogenic hypoglycemia, is associated with mortality.PubMedCrossRef
5.
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;34:256–61.PubMedCrossRef
6.
Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT-2 trial). Diabetes Care. 2007;2181–6.
7.
• Umpierrez GE, Hor T, Smiley D, et al. Comparison of inpatient insulin regimens with detemir plus aspart vs neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94:564–9. This multicenter RCT showed that inpatient basal-bolus therapy achieves equivalent glycemic control to a split-mixed mixed regimen of NPH and regular insulin, with no difference in hypoglycemic events.PubMedCrossRef
8.
•• Turchin A, Matheny ME, Shubina M, et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care. 2009;32:1153–7. This retrospective cohort trial showed that inpatient hypoglycemia in patients with diabetes in the general wards is associated with increased mortality.PubMedCrossRef
9.
Curkensall SM, Natoli JL, Alexander CM, et al. Economic and clinical impact of inpatient diabetic hypoglycemia. Endocr Pract. 2009;15:302–12.CrossRef
10.
Kagansky N, Levy S, Rimon E, et al. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arch Intern Med. 2003;163:1825–9.PubMedCrossRef
11.
Pinto DS, Skolnick AH, Kirtane AJ, et al. U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005;46:178–80.PubMedCrossRef
12.
Pinto DS, Kirtane AJ, Pride YB, et al. Association of blood glucose with angiographic and clinical outcomes among patients with ST-segment elevation myocardial infarction (from the CLARITY-TIMI-28 study). Am J Cardiol. 2008;101:303–7.PubMedCrossRef
13.
Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucose normalization and outcomes in patients with acute myocardial infarction. Arch Intern Med. 2009;169:438–46.PubMedCrossRef
14.
Mesotten D, Van den Berghe G. Glycemic targets and approaches to management of the patient with critical illness. Curr Diab Rep. 2012;12:101–7.PubMedCrossRef
15.
Schwartz NS, Clutter WE, Shah SD, Cryer PE. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. JCI. 1987;79:777–81.PubMedCrossRef
16.
Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.PubMedCrossRef
17.
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31.PubMedCrossRef
18.
Dagogo-Jack SE, Craft S, Cryer PE. Hypoglycemia-associated autonomic failure in insulin-dependent diabetes mellitus. JCI. 1993;91:819–28.PubMedCrossRef
19.
Davis MR, Mellman M, Shamoon H. Further defects in counterregulatory responses induced by recurrent hypoglycemia in IDDM. Diabetes. 1992;41:1335–40.PubMedCrossRef
20.
Nordin C. The case for hypoglycaemia as a proarrythmic event: basic and clinical evidence. Diabetologia. 2010;53:1552–61.PubMedCrossRef
21.
Tattersall RB, Gill GV. Unexplained deaths of type 1 diabetic patients. Diabet Med. 1991;8:49–58.PubMedCrossRef
22.
Robinson RTCE, Harris ND, Ireland RH, et al. Mechanisms of abnormal cardiac repolarization during insulin-induced hypoglycemia. Diabetes. 2003;52:1469–74.PubMedCrossRef
23.
Adler GK, Bonyhay I, Failing H, et al. Antecedent hypoglycemia impairs autonomic cardiovascular function: implications for rigorous glycemic control. Diabetes. 2009;58:360–6.PubMedCrossRef
24.
Desouza C, Salazar H, Cheong B, et al. Association of hypoglycemia and cardiac ischemia: a study based on continuous monitoring. Diabetes Care. 2003;26:1485–9.PubMedCrossRef
25.
Johnston SS, Connor C, Aagren M, et al. Evidence linking hypoglycemic events to an increased risk of acute cardiovascular events in patients with type 2 diabetes. Diabetes Care. 2011;34:1164–70.PubMedCrossRef
26.
Lee SP, Yeoh L, Harris ND, et al. Influence of autonomic neuropathy on QTc lengthening during hypoglycemia in type 1 diabetes. Diabetes. 2004;53:1535–42.PubMedCrossRef
27.
Kahn KJ, Myers RE. Insulin-induced hypoglaecyemia in the non-human primate. I. Clinical consequences. Clin Dev Med. 1971;39/40:185–94.
28.
Suh SW, Gum ET, Hamby AM, et al. Hypoglycemic neuronal death is triggered by glucose reperfusion and activation of neuronal NADPH oxidase. J Clin Invest. 2007;117:910–8.PubMedCrossRef
29.
Tkacs NC, Pan Y, Raghupathi R, et al. Cortical Fluoro-Jade staining and blunted adrenomedullary response to hypoglycemia after noncoma hypoglycemia in rats. J Cereb Blood Flow Metab. 2005;25:1645–55.PubMedCrossRef
30.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Long-term effects of diabetes and its treatment on cognitive function. N Engl J Med. 2007;356:1842–52.CrossRef
31.
Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.PubMedCrossRef
32.
Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007;35:2262–7.PubMedCrossRef
33.
Smith WD, Winterstein AG, Johns T, et al. Causes of hyperglycemia and hypoglycemia in adult inpatients. Am J Health Syst Pharm. 2005;62:714–9.PubMed
34.
• Karon BS, Boyd JC, Klee GG. Glucose meter performance criteria for tight glycemic control estimated by simulation modeling. Clin Chem. 2010;56:1091–7. Handheld point-of-care glucose meters have up to 20% allowable error.PubMedCrossRef
35.
Karon BS, Griesmann L, Scott R, et al. Evaluation of the impact of hematocrit and other interference on the accuracy of hospital-based glucose meters. Diabetes Technol Ther. 2008;10:111–20.PubMedCrossRef
36.
Tang Z, Louie RF, Lee JH, et al. Oxygen effects on glucose meter measurements with glucose dehydrogenase- and oxidase-based test strips for point-of-care testing. Crit Care Med. 2001;29:1062–70.PubMedCrossRef
37.
Pidcoke HF, Wade CE, Mann EA, et al. Anemia causes hypoglycemia in intensive care unit patients due to error in single-channel glucometers: methods of reducing patient risk. Crit Care Med. 2010;38:471–6.PubMedCrossRef
38.
•• Casaer MP, Mesotten D, Hermans G, et al. Early vs late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–17. This multicenter RCT showed that late initiation of parenteral nutrition is associated with fewer complications and decreased cost of hospitalization compared with early initiation.PubMedCrossRef
39.
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.PubMedCrossRef
40.
Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomized controlled study. Lancet. 2009;373:547–56.PubMedCrossRef
41.
•• Finfer S, Chittock DR, Su SY, et al. Intensive vs conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97. This multicenter RCT showed that intensive insulin therapy was associated with increased mortality compared with standard therapy.PubMedCrossRef
42.
Brunkhorst F, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.PubMedCrossRef
43.
Preiser JC, Devos P, Ruiz-Santana S, et al. A prospective randomized multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009;35:1738–48.PubMedCrossRef
44.
Malmberg K. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ. 1997;314:1512–5.PubMedCrossRef
45.
Malmberg K, Ryden L, Wedel H, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650–61.PubMedCrossRef
46.
Griesdale DEG, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including the NICE-SUGAR study data. CMAJ. 2009;180:821–7.PubMedCrossRef
47.
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.PubMedCrossRef
48.
Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with Type 2 diabetes. N Engl J Med. 2008;358:2560–72.PubMedCrossRef
49.
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with Type 2 diabetes. N Engl J Med. 2009;360:129–39.PubMedCrossRef
50.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRef
51.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–53.CrossRef
52.
Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000;S2:B21–9.
53.
UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef
54.
The BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.CrossRef
55.
•• Gruden G, Barutta F, Chaturvedi N, et al. Severe hypoglycemia and cardiovascular disease incidence in type 1 diabetes: the EURODIAB Prospective Complications Trial. Diabetes Care. 2012;35:1598–604. This multicenter prospective trial showed that severe hypoglycemia in patients with type 1 diabetes did not increase the risk of cardiovascular disease.PubMedCrossRef
56.
Kosiborod M, Inzucchi SE, Goyal A, et al. Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA. 2009;301:1556–64.PubMedCrossRef
57.
Mellbin LG, Malmberg K, Waldenstrom A, et al. Prognostic implications of hypoglycaemic episodes during hospitalization for myocardial infarction in patients with type 2 diabetes: a report from the Digami 2 Trial. Heart. 2009;95:721–7.PubMedCrossRef
58.
Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011;154:554–9.PubMed
Metadaten
Titel
Impact of Hypoglycemia in Hospitalized Patients
verfasst von
Michelle Carey
Laura Boucai
Joel Zonszein
Publikationsdatum
01.02.2013
Verlag
Current Science Inc.
Erschienen in
Current Diabetes Reports / Ausgabe 1/2013
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-012-0336-x

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