Background: Kidney injury significantly reduces renal clearance, posing unique challenges for patients with type II diabetes, particularly those on insulin. This reduced clearance can lead to elevated insulin levels, increasing the risk of hypoglycemia and subsequent complications, which often extend the patient’s length of stay (LOS). Chronic kidney disease (CKD) itself is an independent risk factor for hypoglycemia, further compounding the risk already present in diabetic patients. This studyexamines the impact of hypoglycemia on LOS among patients with CKD in observation units, highlighting the critical need for tailored glycemic management in this population to mitigate these risks.
Methods: This retrospective cohort study included all diabetic patients from January 2021 to December 2023 who got placed in the Observation Unit at a large health system in the southwest region of United States and had a routine discharge. Type II diabetic patients and renal failure patients were identified based on ICD code diagnosis (E11 vs N17,N18,N19 respectively).The primary outcome was to compare the rate ofany hypoglycemic event (Glucose < 60mg/dl)and length of Stay (LOS) within different groups. STATA software was used to do statistical analysis.
Results: Of the 46,201 type II diabetes patients included, the mean age (SD) was 66.5 (14.4) years, and 50.9% were females. The overall prevalence of renal failurewas 34.5% (n=15,960). The patients with renal failure had a higher incidence of hypoglycemic eventsas compared to those with normal renal function (6.3% vs 2.6% respectively, p< 0.001). The LOS was higher in renal failure with hypoglycemia compared to no hypoglycemia (30.9 hours vs 26.0 hours, p < 0.0001). Similarly, in the normal renal function group the LOS was higher in patients with hypoglycemic events (27.1 hours vs 25 hours, < 0.0001).
Conclusions: Diabetic patients with kidney injury are at heightened risk of hypoglycemia, even in short-stay Observation Units, leading to an increased length of stay (LOS). Their impaired renal function affects the clearance of diabetic medications, making them more susceptible to hypoglycemic events. It is essential to adjust their diabetic medication regimen with careful consideration of their renal function, ensuring that dosing is appropriate and monitored closely to prevent adverse events