Avoiding Hypoglycemia in the Hospital Setting

Key Points

  • Various patient- and provider-specific factors may increase the risk of inpatient hypoglycemia

  • Hypoglycemia is costly
    • Patient level: increases risk of complications
    • Institutional level: increases cost of care and may reduce reimbursement (Medicare “never” event)

  • Intensive insulin therapy increases the risk of severe hypoglycemia but not hypoglycemia-associated mortality
    • Hypoglycemia predicts higher mortality among hypoglycemic patients who are not receiving insulin, not in patients treated with insulin
    • Hypoglycemia-associated inpatient mortality is not drug-associated but linked to comorbidities

  • Strategies to prevent hypoglycemia
    • Regular glucose monitoring, adjustment of insulin doses, and administration of carbohydrate, IV dextrose, or glucagon as needed
    • Improved communication and coordination between departments (nursing, dietary, transportation, pharmacy)

Suggested Reading

ACE/ADA Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Endocr Pract. 2006;12:458-468.

Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013;369:362-372.

Garber AJ, Moghissi ES, Bransome ED Jr, et al; American College of Endocrinology Task Force on Inpatient Diabetes Metabolic Control. American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endocr Pract. 2004;10:77-82.

Garg R, Jarry A, Pendergrass M. Delay in blood glucose monitoring during an insulin infusion protocol is associated with increased risk of hypoglycemia in intensive care units. J Hosp Med. 2009;4:E5-E7.

Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013;347:f4533.

Hanefeld M, Duetting E, Bramlage P. Cardiac implications of hypoglycaemia in patients with diabetes — a systematic review. Cardiovasc Diabetol. 2013;12:135.

Pennsylvania Patient Safety Advisory. Pa Patient Saf Advis. 2010;7:9-17.

Rubin DJ, Golden SH. Hypoglycemia in non-critically ill, hospitalized patients with diabetes: evaluation, prevention, and management. Hosp Pract (1995). 2013;41:109-116.

Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36:1384-1395.