Background:
Severe hypoglycemia in the hospital is associated with adverse patient outcomes. Many factors alter glycemic status, including corticosteroids, diet, enteral or parenteral feedings, surgical procedures, cardiac, renal or hepatic failure, and sepsis. These patient‐associated risk factors are medically managed to prevent hypoglycemic events. However, less data is available regarding systemic‐level factors within the hospital that may also be contributing to poor glycemic control. The purpose of this study was to analyze risk factors within the systems and protocols of Ochsner Medical Center that may be associated with hypoglycemia.
Methods:
All patients with a verified blood glucose < 40 mg/dl who were admitted to the Ochsner Medical Center Main Campus in the six months between January 2012 and June 2012 were included in the study. The frequency, central tendencies and distributions of fourteen systems level variables, including admission team, unit, consultants, presence of insulin drip, frequency of glucose monitoring and others, were examined using STATA version 10.0.
Results:
In a six‐month period, fifty‐four patients were identified with having one or more episodes of severe hypoglycemia. The median length of stay was 11 days with interquartile range of 4 to 19 days. Twenty‐three (42.6%) of the patients with hypoglycemia were admitted to the internal medicine services. Numbers of hypoglycemic events were relatively evenly distributed across units with the greatest number occurring in the intensive care unit (20.4%) followed by the 5th floor Med/Surg unit and the 8th floor Heme‐Onc unit (14.8% each). A higher number of hypoglycemic events were noted in patients who were monitored with standard mealtime and nighttime accu‐checks when compared to patients on an insulin drip that were more closely monitored. The majority of cases (57.4%) occurred in patients on whom no consultations were requested. Severe hypoglycemia was associated with mortality in sixteen percent of the studied population, the majority in patients with multi‐organ failure.
Conclusions:
Hypoglycemia is a multifactorial problem in the hospital. Providers should note and control medical risk factors to prevent hypoglycemia, with particular attention to medications as well as monitoring and titration of glycemic status. Given that internal medicine physicians often care for patients with diabetes and known hypoglycemic risk factors, education should be directed towards appropriate prescriber orders by this group, particularly for insulin. Difficulties with glycemic control may require assistance with subspecialty consultation, especially in high‐risk patients. Future research should focus on systems and protocols to provide a safer environment for patients in the hospital setting.