Hypoglycemia-associated Mortality Is Not Drug-associated but Linked to Comorbidities - 20/10/11
, William N. Southern, MD, MS a, c, Joel Zonszein, MD, CDE, FACP, FACE a, b
Requests for reprints should be addressed to Laura Boucai, MD, MS, Montefiore Medical Center, Department of Medicine, Division of Endocrinology and Metabolism, 1300 Morris Park Avenue, Belfer Building 701, Bronx, NY 10461Abstract |
Objective |
Although tight glucose control is used widely in hospitalized patients, there is concern that medication-induced hypoglycemia may worsen patient outcomes. We sought to determine if the mortality risk associated with hypoglycemia in hospitalized noncritically ill patients is linked to glucose-lowering medications (drug-associated hypoglycemia) or merely an association mediated by comorbidities (spontaneous hypoglycemia).
Methods |
A retrospective cohort of patients admitted to the general wards of an academic center during 2007 was studied. The in-hospital mortality risk of a hypoglycemic group (at least 1 blood glucose≤70 mg/dL) was compared with that of a normoglycemic group using survival analysis. Stratification by subgroups of patients with spontaneous and drug-associated hypoglycemia was performed.
Results |
Among 31,970 patients, 3349 (10.5%) had at least 1 episode of hypoglycemia. Patients with hypoglycemia were older, had more comorbidities, and received more antidiabetic agents. Hypoglycemia was associated with increased in-hospital mortality (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.33-2.09; P<.001). However, this greater risk was limited to patients with spontaneous hypoglycemia (HR, 2.62; 95% CI, 1.97-3.47; P<.001) and not to patients with drug-associated hypoglycemia (HR, 1.06; 95% CI, 0.74-1.52; P=.749). After adjustment for patient comorbidities, the association between spontaneous hypoglycemia and mortality was eliminated (HR, 1.11; 95% CI, 0.76-1.64; P=.582).
Conclusion |
Drug-associated hypoglycemia was not associated with increased mortality risk in patients admitted to the general wards. The association between spontaneous hypoglycemia and mortality was eliminated after adjustment for comorbidities, suggesting that hypoglycemia may be a marker of disease burden rather than a direct cause of death.
El texto completo de este artículo está disponible en PDF.Keywords : Hypoglycemia, Hypoglycemia in general ward patients, Mortality
Esquema
| Funding: This publication was made possible by the Clinical and Translational Science Award Grant UL1 RR025750 and KL2 RR025749 and TL1 RR025748 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessary represent the official view of the National Center for Research Resources or NIH. |
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| Conflict of Interest: LB, WNS, and JZ have not received any support from any organization for the submitted work. LB and WNS have no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years. JZ serves on an advisory panel for Takeda Pharmaceutical North America and on the speakers bureau for Amylin Pharmaceuticals, Eli Lilly, Merck, Novo Nordisk, and Sanofi-Aventis. |
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| Authorship: LB, WNS, and JZ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. LB designed the study, researched the data, wrote, reviewed, and edited the manuscript. WNS contributed to data collection, researched the data, and contributed to writing, reviewing, and editing the manuscript. JZ contributed to designing the study, writing, reviewing, and editing the manuscript. |
Vol 124 - N° 11
P. 1028-1035 - novembre 2011 Regresar al número
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