Low blood glucose levels in hospitalized patients linked to increased mortality risk

The study's publication comes as a coalition of diabetes stakeholders issues a strategic and actionable blueprint to address the deadly threat hypoglycemia poses to people with diabetes.

More than 29 million Americans are living with diabetes and an additional 86 million are at risk for developing the disease, according to the Society's Endocrine Facts & Figures Report. One complication of diabetes, hypoglycemia, occurs most often in people taking medications to manage their blood sugar. These treatments can raise insulin levels too high, which can in turn cause blood glucose levels to drop too low. Hypoglycemia can be dangerous and, depending on the severity, can lead to various symptoms, including dizziness, confusion, anxiety, seizure or loss of consciousness.

"Hypoglycemia is common among hospitalized patients with and without diabetes mellitus," said the study's senior author, Amit Akirov, MD, of Rabin Medical Center in Petah Tikva, Israel. "Our findings suggest that hypoglycemia, whether insulin-related or non-insulin related, is associated with short- and long-term mortality risk."

This study included nearly 3,000 patients with hypoglycemia, defined as blood glucose levels lower than 70 mg/dl, during hospitalization at a 1,330-bed university-affiliated medical center. Researchers evaluated medical records and the hospital's mortality database to investigate the association between hypoglycemia and mortality in hospitalized patients. They found that for patients with hypoglycemia, 31.9 percent had died at the end of the follow-up period.

Mortality risk was higher in insulin-treated patients with moderate hypoglycemia (40-70 mg/dL), compared to patients without insulin treatment with similar glucose values. However, with severe hypoglycemia (<40 mg/dl), the increase in mortality risk was similar with insulin-related and non-insulin related hypoglycemia. Cause of admission did not affect the association between glucose levels and mortality.

"These data are a timely reminder that hypoglycemia of any cause carries the association with increased mortality," said Akirov.

To increase awareness of hypoglycemia in people with diabetes and to foster initiatives focused on reducing its incidence, the Endocrine Society established the Hypoglycemia Quality Collaborative (HQC), a coalition of medical specialty societies, payers, industry, patient advocates, diabetes educators and research organizations.

The new HQC blueprint provides recommendations and tactics in multiple strategic areas including reducing gaps in care, advocating for increased focus on hypoglycemia and improving quality of care for patients who experience hypoglycemia.

Recommendations include:

• Federal government should increase funding for research at the National Institutes of Health and the Centers for Disease Control and Prevention to reduce gaps in evidence related to hypoglycemia prevention and management;
• Payers and providers should actively consider ways to incorporate continuous glucose monitoring data into clinical decision making for prevention and management of hypoglycemia in high risk individuals;
• Diabetes educators, patient advocacy groups and social workers should engage patients and caregivers regarding self-management techniques as well as protective rights in the workplace; and
• Hypoglycemia-specific education should be targeted by age and gender, sensitive to the number of hours a patient has available, and ideally include training from behaviorists, nurses, dietitians, and exercise physiologists.