Identifying Causes and Improving Hypoglycemia in Hospitalized Patients

Objective:
A significant cause for adverse outcomes in hospitalized patients is hypoglycemia. It is known to increase morbidity and mortality, lengthen hospital stay, and subsequently increase health care costs. Therefore, reducing inpatient hypoglycemia is an urgent concern that must be addressed. The purpose of our study is to investigate the prevalence of hypoglycemic episodes and identify the causes and risk factors leading to hypoglycemia in the hospital setting.

Methods:
We performed a retrospective cross sectional analysis of adult patients 18 years and older who were admitted to our hospital and had a hypoglycemic event, defined as glucose ≤55 mg/dL, between February 2022 and May 2022. A chart review was conducted to identify cause and associated comorbidities.

Results:
We evaluated 667 episodes of hypoglycemia occurring in 409 adult patients hospitalized during a twelve-week period at a tertiary care hospital. Forty-six percent of the patients had diabetes mellitus. Fifty percent of the hypoglycemic incidents occurred in the intensive care unit (ICU) and surgical wards. Hypoglycemia occurred most frequently due to decreased caloric intake related to critical illness and fasting orders (40%) followed by insulin-induced hypoglycemia (32%). Other causes included spontaneous hypoglycemia and discrepancy between serum and capillary blood glucose (26%) and unexplained hypoglycemia due to insufficient data (3%).

Discussion/Conclusion:
Hypoglycemic events were most frequently caused by decreased caloric intake due to critical illness, fasting orders, and insulin administration. Less than half of the patient population had diabetes. Therefore, improving nutritional status in critically ill patients and optimizing their glycemic monitoring/insulin management are two identified areas where intervention can improve inpatient hypoglycemia rates.

Improving the nutritional status of critical ill patients requires multidisciplinary collaboration. The importance of early initiation of feeding and daily assessment of nutritional needs should be reinforced. Decreasing insulin-related hypoglycemia requires early detection and improved insulin management. In our hospital, we will be implementing an automated consult system where the primary care team will be prompted to consider an endocrinology consult through the electronic medical record if a patient meets the predetermined criteria for hypoglycemia during their hospital. One solution will not fit all, but by identifying and addressing areas with high rates of hypoglycemia, we hope to improve inpatient hypoglycemia and patient outcomes.