Hypoglycemia and Hyperglycemia in Hospitalized Patients Receiving Insulin
|Leblond J1*, Beauchesne MF1-4, Bernier F3,5,6, Lanthier L5,6, Garant MP3, Blais L2,4, Frédéric Grondin RN7 and B Cossette B1,6|
|1Department of Pharmacy, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada|
|2Faculty of Pharmacy, Université de Montréal, Montréal, Canada|
|3CR-CHUS, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada|
|4Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada|
|5Department of Medicine, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada|
|6Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada|
|7Department of Nursing, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada|
|Corresponding Author :||Leblond J
Centre hospitalier universitaire de Sherbrooke
3001, 12th Avenue North, Sherbrooke, Quebec, Canada
E-mail: [email protected]
|Received: November 10, 2015; Accepted: November 20, 2015; Published: November 22, 2015|
|Citation: Leblond J, Beauchesne MF, Bernier F, Lanthier L, Garant MP, et al. (2015) Hypoglycemia and Hyperglycemia in Hospitalized Patients Receiving Insulin. Adv Pharmacoepidemiol Drug Saf 4:195. doi:10.4172/2167-1052.1000195|
|Copyright: © 2015 Leblond J, et al . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Background: Insulin is commonly prescribed to treat hyperglycemia in the hospital setting, but is associated with a risk of hypoglycemia. The objective of this study was to determine the incidence rate and risk factors for hypoglycemia and hyperglycemia in hospitalized patients receiving insulin.
Method: Retrospective cohort study analysing 58,496 patient-days of insulin exposure from 7780 hospitalizations of 5537 adult subjects at a teaching hospital between July 2009 and June 2011. The incidence rate of hypoglycemia (glycemia ≤ 3.9 mmol/L) and hyperglycemia (glycemia >16.7 mmol/L) were evaluated. Glycemia was measured by point-of-care blood-glucose. The association between risk factors and hypoglycemia/hyperglycemia events was determined using a Cox model.
Results: The incidence rates for days with hypoglycemia were 11.1 per 100 patient-days for subcutaneous (s.c.) insulin and 10.4 per 100 patient-days for continuous intravenous insulin (CII). The incidence rates for days with hyperglycemia were 10.2 and 4.6 per 100 patient-days for s.c. insulin and CII, respectively. Clinically relevant risk factors associated with hypoglycemia for subjects on s.c. insulin were: creatinine clearance ≤ 60 mL/min: adjusted hazard ratio (HR) 1.14 [95% CI: 1.03-1.27]; surgery: HR 1.23 [95% CI: 1.04-1.46]; and diabetes: HR 1.79 [95% CI: 1.44-2.23]. For hyperglycemia, the risk factors were diabetes: HR 5.10 [95% CI: 3.65-7.12]; use of systemic corticosteroids: HR 2.13 [95% CI: 1.90-2.38]; and prescription of scheduled with sliding scale insulin: HR 1.89 [95% CI: 1.62-2.21]. ]
Conclusion: The identified risk factors indicate areas for targeted improvement initiatives for glycemic control and should help reduce the rate of hyperglycemic and hypoglycemic events, thereby decreasing the occurrence of adverse outcomes.