Impact of glycemic variability and hypoglycemia on adverse hospital outcomes in non-critically ill patients

Yoojin Kim, Kumar Rajan, Shannon A. Sims, Kristen E. Wroblewski, Sirimon Reutrakul

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aims: To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia. Methods: A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF). Results: There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2. ±. 11.1. Hypoglycemia (POCG ≤70. mg/dl [3.9. mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p= 0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p= 0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p= <0.001] and an increase of 2 days in LOS for those with average %CV. Conclusions: Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.

Original languageEnglish (US)
Pages (from-to)437-443
Number of pages7
JournalDiabetes Research and Clinical Practice
Volume103
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Hypoglycemia
Length of Stay
Point-of-Care Systems
Cross Infection
Acute Kidney Injury
Glucose
Patient Admission
Hospitalization
Insulin

Keywords

  • Glycemic variability
  • Hospitalization outcomes
  • Hypoglycemia
  • Length of stay
  • Non-critically ill

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

Cite this

Impact of glycemic variability and hypoglycemia on adverse hospital outcomes in non-critically ill patients. / Kim, Yoojin; Rajan, Kumar; Sims, Shannon A.; Wroblewski, Kristen E.; Reutrakul, Sirimon.

In: Diabetes Research and Clinical Practice, Vol. 103, No. 3, 01.01.2014, p. 437-443.

Research output: Contribution to journalArticle

Kim, Yoojin ; Rajan, Kumar ; Sims, Shannon A. ; Wroblewski, Kristen E. ; Reutrakul, Sirimon. / Impact of glycemic variability and hypoglycemia on adverse hospital outcomes in non-critically ill patients. In: Diabetes Research and Clinical Practice. 2014 ; Vol. 103, No. 3. pp. 437-443.
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AU - Reutrakul, Sirimon

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AB - Aims: To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia. Methods: A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF). Results: There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2. ±. 11.1. Hypoglycemia (POCG ≤70. mg/dl [3.9. mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p= 0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p= 0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p= <0.001] and an increase of 2 days in LOS for those with average %CV. Conclusions: Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.

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KW - Hospitalization outcomes

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KW - Length of stay

KW - Non-critically ill

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