Volume 200 - Issue 2
Notifying a doctor of a first hypoglycaemic episode is associated with a lower rate of recurrence among inpatients with diabetes
Authors: Dilantha T De Alwis, Suresh Varadarajan and Kwang Lim
Med J Aust 2014; 200 (2): 79. || doi: 10.5694/mja13.11014
Published online: 3 February 2014
Published online: 3 February 2014
To the Editor: Hypoglycaemia is a common problem in inpatients with diabetes and is associated with morbidity and mortality.,2 We conducted a retrospective single-centre cohort study to evaluate the management (notifying a doctor and taking appropriate preventive actions, defined as altering the hypoglycaemic agent that led to the event or commencing dextrose in appropriate cases by the doctor) of the first hypoglycaemic episode and its ...
To the Editor: Hypoglycaemia is a common problem in inpatients with diabetes and is associated with morbidity and mortality.1,2 We conducted a retrospective single-centre cohort study to evaluate the management (notifying a doctor and taking appropriate preventive actions, defined as altering the hypoglycaemic agent that led to the event or commencing dextrose in appropriate cases by the doctor) of the first hypoglycaemic episode and its impact on recurrence and length of stay.
We evaluated the first hypoglycaemic episode (capillary glucose level < 3.5 mmol/L) of all 915 patients with diabetes admitted to our inpatient ward over 3 months, from January to March 2012. One hundred patients experienced one or more hypoglycaemic episodes and, of these, 57 experienced recurrences. For 19 patients, a doctor was notified of the first episode. Recurrence was seen in six of these patients, compared with 51 of the 81 patients for whom a doctor was not notified of the first episode (P = 0.013). Severe hypoglycaemia (< 2.5 mmol/L) was seen in 11/19 patients during the first episode in the doctor-notified group and in 18/81 patients in the doctor-not-notified group. Age, hypoglycaemic agents, symptoms and after-hours occurrence were similar between groups.
Twelve patients were admitted twice during this time. For 10 of the readmitted patients, a doctor was not notified during the first admission and, for 11 patients, a doctor was not notified during the second admission. Of the doctor-not-notified patients, five and seven in the first and second admissions, respectively, experienced a recurrence. However, none of the doctor-notified patients experienced a recurrence.
Appropriate preventive action was taken for 14/19 patients in the doctor-notified group, compared with 28/81 patients in the doctor-not-notified group (P = 0.002). Recurrence occurred in 21 of the 42 patients for whom appropriate action was taken, compared with 36 of the 58 patients for whom it was not taken (P = 0.31).
Recurrent hypoglycaemia was associated with longer length of stay: 13.5 days v 7.5 days for a single occurrence (P = 0.035).
In our study, 10% of patients hospitalised with diabetes had a hypoglycaemic episode, which is similar to previously documented rates.3 The association between notifying a doctor of the first hypoglycaemic event and a lower recurrence rate highlights the importance of notification and appropriate management of the first episode. The association with longer length of stay is similar to that previously observed.4 A causal effect is difficult to infer due to many confounding factors and the retrospective nature of the study. As expected, there was an association between appropriate action and doctor notification. The lack of association between appropriate action and recurrences may be due to small sample size or other factors that were not classified as appropriate action.
Competing interests
No relevant disclosures.
References
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- Wexler DJ, Meigs JB, Cagliero E, et al. Prevalance of hyper- and hypoglycemia among inpatients with diabetes: a national survey of 44 US hospitals. Diabetes Care 2007; 30: 367-369. 0_i1142869
- Turchin A, Matheny ME, Shubina M, et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 2009; 32: 1153-1157. 0_CBBGJGBJ