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Author Notes:

Corresponding Author: Guillermo E. Umpierrez, M.D., Emory University School of Medicine, Grady Health System, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303. Email: geumpie@emory.edu.

The sponsors of these studies were not involved in the study design, data collection, analysis or interpretation of the results, or preparation of the manuscript.

Subjects:

Research Funding:

RABITT-2 and RABBIT Surgery trials were investigator-initiated studies supported by unrestricted grants from sanofi aventis (Bridgewater, NJ).

The DEAN trial was an investigator-initiated study supported by unrestricted grants from Novo Nordisk Pharmaceuticals (Bridgewater, NJ).

Guillermo Umpierrez is supported in part by research grants from the American Diabetes Association (7-03-CR-35) and PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources. Dawn Smiley receives research support from the National Institute of Health (K08 DK0830361).

Keywords:

  • basal insulin
  • detemir
  • glargine
  • hospital hyperglycemia
  • hypoglycemia
  • neutral protamine Hagedorn
  • sliding scale insulin

Risk Factors for Inpatient Hypoglycemia during Subcutaneous Insulin Therapy in Non-Critically Ill Patients with Type 2 Diabetes

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Journal Title:

Journal of Diabetes Science and Technology

Volume:

Volume 6, Number 5

Publisher:

, Pages 1022-1029

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: We aimed to determine risk factors associated with hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes. Methods: We conducted an analysis of three randomized control trials using basal/bolus regimen and regular sliding scale insulin (SSI) in patients with diabetes admitted to medical and surgical settings. Results: We analyzed medical records of 261 general medicine and 211 noncardiac surgery patients treated with basal/bolus regimen with glargine/glulisine (n = 169), detemir/aspart (n = 67), neutral protamine Hagedorn/regular (n = 63), or with SSI (n = 173). The overall frequency of mild and severe hypoglycemia (<70 and <40 mg/dl) was 19% and 2%, respectively. During treatment, medical patients experienced a higher number of hypoglycemia than surgical patients (23% versus 13%; p = .005), but the rate of severe hypoglycemia was similar between groups (1.9% versus 1.9%; p = not significant). Increasing age, impaired kidney function (glomerular filtration rate < 60 ml/min), total daily insulin dose, and type of insulin regimen (basal/bolus versus SSI) during hospitalization were important contributors for hypoglycemia in both medical and surgical patients. Among these variables, increasing age and type of insulin regimen (basal/bolus versus SSI) were found to be independent predictors of hypoglycemic events. Conclusions: Mild hypoglycemic events are common during subcutaneous insulin therapy in medical and surgical patients with type 2 diabetes. Increasing age, impaired renal function, daily insulin dose, and insulin regimen (basal/bolus versus SSI) are important predictors of hypoglycemia during insulin therapy in patients with type 2 diabetes mellitus.

Copyright information:

© 2012 Diabetes Technology Society

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