Inpatient hypoglycaemia: understanding who is at risk
Aims/hypothesis We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia. Methods The study was conducted using electronic patient record data from Oxford...
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| Veröffentlicht in: | Diabetologia 2020-07, Vol.63 (7), p.1299-1304 |
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| creator | Ruan, Yue Moysova, Zuzana Tan, Garry D. Lumb, Alistair Davies, Jim Rea, Rustam D. |
| description | Aims/hypothesis
We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia.
Methods
The study was conducted using electronic patient record data from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for patients coded for diabetes. We used the recently agreed definition for a level 1 hypoglycaemia episode as any blood glucose measurement |
| doi_str_mv | 10.1007/s00125-020-05139-y |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7286944</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2411432451</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-95a08835b21dbc06fecd43d0736ec84c2c0f1aa3185b6a19a04f3cf93e0331233</originalsourceid><addsrcrecordid>eNp9kTlPxDAQhS0EguX4AxQoEg1NYMbjXBRICHFJSDQg0Vlex9k1ZJ3FTkD592RZ7oJqivfNm-MxtotwiADZUQBAnsTAIYYEqYj7FTZCQTwGwfNVNlroMebpwwbbDOERACgR6TrbIE4AOccRS67dXLXWuDaa9vNmUvdamZlVx1HnSuNDq1xp3SR6nTaRDZFqI2_D0zZbq1QdzM5H3WL3F-d3Z1fxze3l9dnpTaxFJtq4SBTkOSVjjuVYQ1oZXQoqIaPU6FxorqFCpQjzZJwqLBSIinRVkAEi5ERb7GTpO-_GM1PqYU2vajn3dqZ8Lxtl5W_F2amcNC8y43laCDEYHHwY-Oa5M6GVMxu0qWvlTNMFyanAIiMUOKD7f9DHpvNuOE9ygYu3imRB8SWlfROCN9XXMghykYpcpiKHVOR7KrIfmvZ-nvHV8hnDANASCIPkJsZ_z_7H9g2mnZgb</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2411432451</pqid></control><display><type>article</type><title>Inpatient hypoglycaemia: understanding who is at risk</title><source>Springer Nature - Complete Springer Journals</source><creator>Ruan, Yue ; Moysova, Zuzana ; Tan, Garry D. ; Lumb, Alistair ; Davies, Jim ; Rea, Rustam D.</creator><creatorcontrib>Ruan, Yue ; Moysova, Zuzana ; Tan, Garry D. ; Lumb, Alistair ; Davies, Jim ; Rea, Rustam D.</creatorcontrib><description>Aims/hypothesis
We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia.
Methods
The study was conducted using electronic patient record data from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for patients coded for diabetes. We used the recently agreed definition for a level 1 hypoglycaemia episode as any blood glucose measurement <4 mmol/l and a level 2 hypoglycaemia episode as any blood glucose measurement <3 mmol/l. Any two or more consecutive low blood glucose measurements within a 2 h time window were considered as one single hypoglycaemic episode.
Results
We analysed data obtained from 17,658 inpatients with diabetes (1696 with type 1 diabetes, 14,006 with type 2 diabetes, and 1956 with other forms of diabetes; 9277 men; mean ± SD age, 66 ± 18 years) who underwent 32,758 hospital admissions between July 2014 and August 2018. The incidence of level 1 hypoglycaemia was 21.5% and the incidence of level 2 hypoglycaemia was 9.6%. Recurrent level 1 and level 2 hypoglycaemia occurred, respectively, in 51% and 39% of hospital admissions in people with type 2 diabetes with at least one hypoglycaemic episode, and in 55% and 45% in those with type 1 diabetes. The incidence of level 2 hypoglycaemia in people with type 2 diabetes, when corrected for the number of people who remained in hospital, remained constant for the first 100 h at approximately 0.15 events per h per admission. With regards to the hypoglycaemia distribution during the day, after correcting for the number of blood glucose tests per h, there were two clear spikes in the rate of hypoglycaemia approximately 3 h after lunch and after dinner. The highest rate of hypoglycaemia per glucose test was seen between 01:00 hours and 05:00 hours. Medication had a significant impact on the incidence of level 2 hypoglycaemia, ranging from 1.5% in people with type 2 diabetes on metformin alone to 33% in people treated with a combination of rapid-acting insulin analogue, long-acting insulin analogue and i.v.-administered insulin.
Conclusions/interpretation
Retrospective analysis of data from electronic patient records enables clinicians to gain a greater understanding of the incidence and distribution of inpatient hypoglycaemia. This information should be used to drive evidence-based improvements in the glycaemic control of inpatients through targeted medication adjustment for specific populations at high risk of hypoglycaemia.</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-020-05139-y</identifier><identifier>PMID: 32300821</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood glucose ; Diabetes ; Diabetes mellitus (insulin dependent) ; Diabetes mellitus (non-insulin dependent) ; Firing rate ; Glucose ; Human Physiology ; Hypoglycemia ; Insulin ; Internal Medicine ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Metformin ; Patient admissions ; Patients ; Short Communication</subject><ispartof>Diabetologia, 2020-07, Vol.63 (7), p.1299-1304</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-95a08835b21dbc06fecd43d0736ec84c2c0f1aa3185b6a19a04f3cf93e0331233</citedby><cites>FETCH-LOGICAL-c474t-95a08835b21dbc06fecd43d0736ec84c2c0f1aa3185b6a19a04f3cf93e0331233</cites><orcidid>0000-0001-6515-8325</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00125-020-05139-y$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00125-020-05139-y$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32300821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruan, Yue</creatorcontrib><creatorcontrib>Moysova, Zuzana</creatorcontrib><creatorcontrib>Tan, Garry D.</creatorcontrib><creatorcontrib>Lumb, Alistair</creatorcontrib><creatorcontrib>Davies, Jim</creatorcontrib><creatorcontrib>Rea, Rustam D.</creatorcontrib><title>Inpatient hypoglycaemia: understanding who is at risk</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia.
Methods
The study was conducted using electronic patient record data from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for patients coded for diabetes. We used the recently agreed definition for a level 1 hypoglycaemia episode as any blood glucose measurement <4 mmol/l and a level 2 hypoglycaemia episode as any blood glucose measurement <3 mmol/l. Any two or more consecutive low blood glucose measurements within a 2 h time window were considered as one single hypoglycaemic episode.
Results
We analysed data obtained from 17,658 inpatients with diabetes (1696 with type 1 diabetes, 14,006 with type 2 diabetes, and 1956 with other forms of diabetes; 9277 men; mean ± SD age, 66 ± 18 years) who underwent 32,758 hospital admissions between July 2014 and August 2018. The incidence of level 1 hypoglycaemia was 21.5% and the incidence of level 2 hypoglycaemia was 9.6%. Recurrent level 1 and level 2 hypoglycaemia occurred, respectively, in 51% and 39% of hospital admissions in people with type 2 diabetes with at least one hypoglycaemic episode, and in 55% and 45% in those with type 1 diabetes. The incidence of level 2 hypoglycaemia in people with type 2 diabetes, when corrected for the number of people who remained in hospital, remained constant for the first 100 h at approximately 0.15 events per h per admission. With regards to the hypoglycaemia distribution during the day, after correcting for the number of blood glucose tests per h, there were two clear spikes in the rate of hypoglycaemia approximately 3 h after lunch and after dinner. The highest rate of hypoglycaemia per glucose test was seen between 01:00 hours and 05:00 hours. Medication had a significant impact on the incidence of level 2 hypoglycaemia, ranging from 1.5% in people with type 2 diabetes on metformin alone to 33% in people treated with a combination of rapid-acting insulin analogue, long-acting insulin analogue and i.v.-administered insulin.
Conclusions/interpretation
Retrospective analysis of data from electronic patient records enables clinicians to gain a greater understanding of the incidence and distribution of inpatient hypoglycaemia. This information should be used to drive evidence-based improvements in the glycaemic control of inpatients through targeted medication adjustment for specific populations at high risk of hypoglycaemia.</description><subject>Blood glucose</subject><subject>Diabetes</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Firing rate</subject><subject>Glucose</subject><subject>Human Physiology</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Metformin</subject><subject>Patient admissions</subject><subject>Patients</subject><subject>Short Communication</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kTlPxDAQhS0EguX4AxQoEg1NYMbjXBRICHFJSDQg0Vlex9k1ZJ3FTkD592RZ7oJqivfNm-MxtotwiADZUQBAnsTAIYYEqYj7FTZCQTwGwfNVNlroMebpwwbbDOERACgR6TrbIE4AOccRS67dXLXWuDaa9vNmUvdamZlVx1HnSuNDq1xp3SR6nTaRDZFqI2_D0zZbq1QdzM5H3WL3F-d3Z1fxze3l9dnpTaxFJtq4SBTkOSVjjuVYQ1oZXQoqIaPU6FxorqFCpQjzZJwqLBSIinRVkAEi5ERb7GTpO-_GM1PqYU2vajn3dqZ8Lxtl5W_F2amcNC8y43laCDEYHHwY-Oa5M6GVMxu0qWvlTNMFyanAIiMUOKD7f9DHpvNuOE9ygYu3imRB8SWlfROCN9XXMghykYpcpiKHVOR7KrIfmvZ-nvHV8hnDANASCIPkJsZ_z_7H9g2mnZgb</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Ruan, Yue</creator><creator>Moysova, Zuzana</creator><creator>Tan, Garry D.</creator><creator>Lumb, Alistair</creator><creator>Davies, Jim</creator><creator>Rea, Rustam D.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6515-8325</orcidid></search><sort><creationdate>20200701</creationdate><title>Inpatient hypoglycaemia: understanding who is at risk</title><author>Ruan, Yue ; Moysova, Zuzana ; Tan, Garry D. ; Lumb, Alistair ; Davies, Jim ; Rea, Rustam D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-95a08835b21dbc06fecd43d0736ec84c2c0f1aa3185b6a19a04f3cf93e0331233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood glucose</topic><topic>Diabetes</topic><topic>Diabetes mellitus (insulin dependent)</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Firing rate</topic><topic>Glucose</topic><topic>Human Physiology</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Metformin</topic><topic>Patient admissions</topic><topic>Patients</topic><topic>Short Communication</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruan, Yue</creatorcontrib><creatorcontrib>Moysova, Zuzana</creatorcontrib><creatorcontrib>Tan, Garry D.</creatorcontrib><creatorcontrib>Lumb, Alistair</creatorcontrib><creatorcontrib>Davies, Jim</creatorcontrib><creatorcontrib>Rea, Rustam D.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruan, Yue</au><au>Moysova, Zuzana</au><au>Tan, Garry D.</au><au>Lumb, Alistair</au><au>Davies, Jim</au><au>Rea, Rustam D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inpatient hypoglycaemia: understanding who is at risk</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>63</volume><issue>7</issue><spage>1299</spage><epage>1304</epage><pages>1299-1304</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
We analysed data obtained from the electronic patient records of inpatients with diabetes admitted to a large university hospital to understand the prevalence and distribution of inpatient hypoglycaemia.
Methods
The study was conducted using electronic patient record data from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for patients coded for diabetes. We used the recently agreed definition for a level 1 hypoglycaemia episode as any blood glucose measurement <4 mmol/l and a level 2 hypoglycaemia episode as any blood glucose measurement <3 mmol/l. Any two or more consecutive low blood glucose measurements within a 2 h time window were considered as one single hypoglycaemic episode.
Results
We analysed data obtained from 17,658 inpatients with diabetes (1696 with type 1 diabetes, 14,006 with type 2 diabetes, and 1956 with other forms of diabetes; 9277 men; mean ± SD age, 66 ± 18 years) who underwent 32,758 hospital admissions between July 2014 and August 2018. The incidence of level 1 hypoglycaemia was 21.5% and the incidence of level 2 hypoglycaemia was 9.6%. Recurrent level 1 and level 2 hypoglycaemia occurred, respectively, in 51% and 39% of hospital admissions in people with type 2 diabetes with at least one hypoglycaemic episode, and in 55% and 45% in those with type 1 diabetes. The incidence of level 2 hypoglycaemia in people with type 2 diabetes, when corrected for the number of people who remained in hospital, remained constant for the first 100 h at approximately 0.15 events per h per admission. With regards to the hypoglycaemia distribution during the day, after correcting for the number of blood glucose tests per h, there were two clear spikes in the rate of hypoglycaemia approximately 3 h after lunch and after dinner. The highest rate of hypoglycaemia per glucose test was seen between 01:00 hours and 05:00 hours. Medication had a significant impact on the incidence of level 2 hypoglycaemia, ranging from 1.5% in people with type 2 diabetes on metformin alone to 33% in people treated with a combination of rapid-acting insulin analogue, long-acting insulin analogue and i.v.-administered insulin.
Conclusions/interpretation
Retrospective analysis of data from electronic patient records enables clinicians to gain a greater understanding of the incidence and distribution of inpatient hypoglycaemia. This information should be used to drive evidence-based improvements in the glycaemic control of inpatients through targeted medication adjustment for specific populations at high risk of hypoglycaemia.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32300821</pmid><doi>10.1007/s00125-020-05139-y</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6515-8325</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Blood glucose Diabetes Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Firing rate Glucose Human Physiology Hypoglycemia Insulin Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Metformin Patient admissions Patients Short Communication |
| title | Inpatient hypoglycaemia: understanding who is at risk |
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