SAT144 Hospital Hypoglycemia: An Analysis Of Risk Factors And Patients Outcomes

Abstract

Abstract Disclosure: A.R. Pichardo-Lowden: None. S.G. Goud: None. T.M. Gallagher: None. E.B. Lehman: None. M.D. Bolton: None. P.A. Homburger: None. K.M. Kearcher: None. Inpatient hypoglycemia (HG) is prevalent and often preventable. Whether an indicator of disease severity or a consequence of management, it conveys worse outcomes and costs. HG prevention is a quality and safety endeavor denoting hospitals performance. We examined risk factors and HG contribution to mortality, hospital length of stay (LOS), charges and readmissions. We defined HG as glucose ≤40 mg/dl (severe), >40 - ≤70 mg/dl (moderate), and euglycemia >70 mg/dl. Electronic health record data was extracted using a business intelligence tool. A retrospective analysis of adults (≥18 y) with diabetes (DM) admitted to a quaternary center compared HG vs. euglycemia. HG was the primary outcome predictor in multivariable models adjusted for covariates, including severity of illness (SOI). The analysis included 54,358 admissions with type 1 (7.2%) or 2 (92.8%) DM admitted to medical (66.8%), surgical (30.3%), and other services (2.9%) in intensive (ICU) (7.3%) and non-ICU (92.7%) over 10 years. Subjects had at least one moderate (M) 9,713 (17.9%) or severe (S) 1,950 (3.6%) HG event. Factors significantly associated with either M or S HG in the hospital included TIDM (P=<0.001), preadmission insulin (P=<0.001) or DM treatment (P=<0.001), receiving insulin (P=<0.001), fasting status (S P=0.001), enteral or parenteral nutrition (P=<0.001), restraints orders (S P=0.002, M P=<0.001), first point-of-care glucose test >12 hours from admission (P=<0.001), ICU status (P=<0.001), high SOI (P=<0.001), altered mental status (P=<0.001), prior admission for HG (P=<0.001), sepsis, acute and chronic kidney injury, and HG unawareness, (P=<0.001) chronic congestive heart failure HF) (S P=0.005, M P=<0.001), acute HF (S P=0.002, M P=<0.001), fall risk (S P=0.006, M P=<0.001), chronic liver disease (M P=0.012). Outcomes analysis revealed that severe HG was associated with in-hospital mortality (P=0.001). Moderate HG was associated with 30-day readmission (P=0.014). Both severe and moderate HG were associated with 90-day mortality (S P=0.002, M P=<0.001,), discharge requiring home care (S P=<0.001, M P<0.001), to a rehabilitation facility (S P=<0.001, M P=<0.001), or skilled nursing facility (S P=<0.001, M P=<0.001), all independent of SOI. Moderate and severe HG increased median LOS (P=<0.001) and median hospital charges (P=<0.001) among severely and non-severely ill subjects. These increases were greater in the high-SOI group versus low-SOI for moderate HG (P=0.044, P=0.027), but not for severe HG (P=1.0, P=1.0). The deleterious consequences of HG independent of SOI, as reported here, depicts HG as the likely cause of poor outcomes, and not just a byproduct of illness. Many factors predisposing to HG are recognizable and can be anticipated in clinical practice. These findings reaffirm the need for preventive measures deployed to hospitals’ systems of practice as strategies to improve outcomes. Presentation: Saturday, June 17, 2023