Risk Factors For Hypoglycemia Research Articles

Low Body Mass Index as a Significant Risk Factor for Hypoglycemia in Hospitalized Elderly Patients With Acute Pyelonephritis: A Retrospective Cohort Study

Low Body Mass Index as a Significant Risk Factor for Hypoglycemia in Hospitalized Elderly Patients With Acute Pyelonephritis: A Retrospective Cohort Study

Risk factors for Relative and Absolute Hypoglycemia in Patients Treated for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome.

Introduction: Glycemic management in the intensive care unit is an evolving practice area. This evolution has included the refinement of blood glucose targets, matching glycemic management to premorbid status, and investigations into the impact of glycemic variability and relative hypoglycemia on ICU outcomes. The interplay between these phenomena and absolute hypoglycemia has yet to be investigated in hyperglycemic emergencies. Objectives: To examine the incidence of and risk factors for relative hypoglycemia and absolute hypoglycemia in patients admitted to an intensive care unit for the management of hyperglycemic emergencies. Methods: This was a retrospective, single-center, exploratory analysis of adults admitted to the medical intensive care unit for diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome. The primary outcome was the incidence of relative hypoglycemia, defined as a blood glucose level 30% lower than baseline. The baseline was determined by the estimated average blood glucose calculated from hemoglobin A1c within 3 months of index admission. Secondary outcomes were ICU length of stay, glycemic variability, and incidence of absolute hypoglycemia.Results: Relative hypoglycemia was observed in 60% of patients in the cohort. Longer insulin infusion duration and higher hemoglobin A1c levels were found to statistically increase the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU length of stay were associated with the risk of developing absolute hypoglycemia. Conclusions: Relative hypoglycemia is a frequent occurrence in this patient population. Hemoglobin A1c and duration of the insulin infusion statistically influenced the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU stay were significantly associated with developing absolute hypoglycemia. While relative hypoglycemia is common in hyperglycemic emergencies, the clinical impact remains uncertain and warrants additional investigation.

Incidence and risk factors of post-metabolic and bariatric surgery hypoglycemia: a systematic review.

This study aimed to systematically review the existing literature to summarize the incidence and risk factors of post-metabolic and bariatric surgery hypoglycemia (MBSH). We searched PubMed, Medline, Embase, and the Cochrane Library databases for the studies published from inception to August 2023. Randomized controlled trials and analytical studies that investigated the incidence or risk factors of MBSH after different surgery techniques (including Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, duodenal switch, omega-loop gastric bypass, and vertical banded gastroplasty) were involved. The incidence and risk factors of MBSH were extracted and described separately based on different diagnostic criteria and then summarized the risk factors and their statistical findings collectively. Twenty-nine studies were reviewed with follow-up ranging from 1 to 22 years. The incidence of MBSH ranged significantly across different diagnostic methods: 2.6-66.4% (self-report), 6.6-61.8% (oral glucose tolerance test), 29.4-78.6% (mixed-meal tolerance test), and 50-75% (continuous glucose monitoring). Patients with a mean age of 49.8 years and 89.0% of them were women with a better glycemic control who undergo RYGB and achieve 86.5% of estimated weight loss from surgery should be particularly vigilant about the possibility of developing MBSH. Distinct biomarkers such as IGF-1 (OR 1.06), fasting glicentin (AUC 0.81), HbA1c (AUC 0.76), and absolute weight reduction (AUC 0.72), greater fluctuations in glucose (OR 1.98) are valuable in promptly detecting MBSH. Specifically, patients with prior cholecystectomy or antidepressant therapy should be particularly cautious. The review highlights higher MBSH risk in younger women with significant weight loss after RYGB, and those with prior cholecystectomy or antidepressant use. Systematic summarization of MBSH criteria allowed us to identify the predictors for MBSH, which can aid in early diagnosis and treatment, reducing the need for prolonged monitoring.

Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target

BACKGROUND In patients with type 2 diabetes mellitus (T2DM), the risk of hypoglycemia also occurs in at a time-in-range (TIR) of > 70%. The hemoglobin glycation index (HGI) is considered the best single factor for predicting hypoglycemia, and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings. AIM To investigate the relationship between HGI and hypoglycemia and the implications of HGI on hypoglycemia in T2DM with TIR > 70%. METHODS All participants underwent a 7-days continuous glucose monitoring (CGM) using a retrospective CGM system. We obtained glycemic variability indices using the CGM system. We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator. Patients were categorized into low HGI (HGI < 0.5) and high HGI groups (HGI ≥ 0.5) according to HGI median (0.5). Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia. RESULTS We included 129 subjects with T2DM (54.84 ± 12.56 years, 46% male) in the study. Median TIR score was 90%. The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group; this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group. Multivariate analyses revealed that mean blood glucose, standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia. Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia. In addition, the optimal cut-off points for HGI, mean blood glucose, and standard deviation of blood glucose in predicting hypoglycemia were 0.5%, 7.2 mmol/L and 1.4 mmol/L respectively. CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR > 70%. Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.

5040 Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior

Abstract Disclosure: J. Ambalavanan: None. J. Rusticelli: None. D. Isaacs: Consulting Fee; Self; Medtronic Diabetes, Lilly USA, LLC, Novo Nordisk, Insulet Corporation, Abbott Laboratories, Dexcom. H. Xiao: None. J. Bena: None. Z. Jin: None. C. Babiuch: None. M. Lansang: Consulting Fee; Self; Glooko. Research Investigator; Self; Abbott Laboratories, Dexcom, Xeris. Background: Hypoglycemia is a major source of anxiety in, and can be life-threatening for, patients with diabetes (DM). Even though the American Diabetes Association (ADA) recommends glucagon be made available to all individuals taking insulin or at high risk for hypoglycemia (level E evidence), few patients have access to this life-saving medication. Given the rapid adoption of continuous glucose monitoring (CGM) in the management of DM, we aimed to 1) evaluate glucagon prescription by identifying patients with hypoglycemia on CGM reports, and 2) deliver an educational letter to the providers. Methods: Our study had a retrospective chart review and a quality improvement (QI) component. From Mar-Oct 2023, we identified adult patients in the Cleveland Clinic Ohio health system with type 1 or type 2 DM on insulin (including insulin pumps), sulfonylurea, or meglitinide, and hypoglycemia defined as time below range (TBR) ≥4% on CGM reports. We evaluated the percentages of pre-existing and incident glucagon prescription among those patients. For the QI component, we contacted providers individually via letter if the patients did not have a glucagon prescription and shared with them the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Whether to prescribe glucagon was left to the clinical judgement of the providers. Information was collected 4 weeks later to see whether there was any change in the prescription practice. Results: Patients numbered 1543, with170 patients having TBR ≥4%. Among patients with hypoglycemia, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p<0.001). Significant (p<0.001) risk factors for hypoglycemia included type 1 DM, insulin-only therapy, use of conventional insulin pumps, and lower A1c. Among patients with TBR ≥4%, 66 (39%) had level 1 hypoglycemia (54 to <70 mg/dl), 88 (52%) had level 2, and 16 (9%) had level 3 (hospitalization or ER admission for hypoglycemia). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with level 1 hypoglycemia, 49% with level 2, and 63% with level 3 (p<0.001 level 1 vs level 3; level 2 vs no hypoglycemia; level 3 vs no hypoglycemia). Among 70 patients whose providers received education letters, 27 (39%) prescribed glucagon after education. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were the top prescription choices. A greater proportion of advanced practice providers responded to our education than physicians (p=0.021). Conclusion: Glucagon prescription remains suboptimal though better than in other studies even among patients with documented hypoglycemia on CGM reports. Effective provider education and communication can increase glucagon prescription. Provider and patient factors should be studied next to determine steps for further improvement. Presentation: 6/1/2024

The Incidence of Hypoglycemia and Its Risk Factors Among Diabetic Patients at Prince Mohammed bin Abdulaziz National Guard Hospital in Al-Madinah Al-Munawwarh, Saudi Arabia

Aims: This study aims to investigate the incidence rate and risk factors for hypoglycemia among individuals with type 1 (T1DM) and type 2 diabetes (T2DM) in Saudi Arabia receiving insulin treatment. Methods: A cross-sectional study was conducted at Prince Mohammed bin Abdulaziz National Guard Hospital in Al-Madinah Al-Munawarah, Saudi Arabia, from 2023 to 2024. The study included 255 diabetic patients aged 18 to 65 years who met the inclusion criteria. Data was collected using a validated questionnaire administered through phone calls, covering sociodemographic characteristics, diabetes type, medical history, hypoglycemia history, and compliance with treatment. Data analysis was performed using SPSS version 21, employing descriptive statistics and logistic regression analysis to identify significant risk factors. Results: Among the 255 participants, 55.3% reported experiencing hypoglycemia, with higher rates observed in patients with type 1 diabetes (100%) compared to type 2 diabetes (55.9%). The study identified significant associations between hypoglycemia and factors such as age, nationality, residence, marital status, and educational level. Additionally, wrong food diet, missing meals, and inadequate knowledge about diabetes management were common causes of hypoglycemic episodes. Most hypoglycemic events (92.5%) occurred outside of the hospital, with 18.6% classified as serious. Conclusions: The findings reveal a high incidence of hypoglycemia among diabetic patients in Saudi Arabia, with a substantial proportion of severe events occurring outside clinical settings. These results highlight the necessity for improved patient education and monitoring strategies to mitigate the risk of hypoglycemia.

Assessment of Correlation Between Glycaemic Variability Indices and Measures of Hypoglycaemia in Patients with Type 2 Diabetes Mellitus

Abstract Introduction: Diabetes mellitus is a global health burden, and India is regarded as the diabetes capital of the world. Glycaemic variability (GV) is an established risk factor for hypoglycaemia (plasma glucose concentration <70 mg/dL) and a notorious risk factor for diabetes complications. The primary aim of the study was to assess the correlation between the GV indices, HbA1c levels, and measures of hypoglycaemia in patients with type 2 DM (T2DM). Methods: In this cross-sectional study, continuous glucose monitoring (CGM) was done for a period of 14 days in T2DM patients (n = 50). The GV indices were determined from the readings obtained from the CGM monitor. Spearman’s rank correlation coefficient was used for correlation analyses. The area under the receiver operating characteristics (ROC) curve was used to assess the effectiveness of the various GV indices in predicting hypoglycaemia. Results: A total of 50 T2DM patients had a mean (SD) age of 61.84 ± 11.88 years. Among the GV indices, high blood glucose index (HBGI), average daily risk range (ADRR), and continuous overall net glycaemic action (CONGA) had a significantly positive correlation with HbA1c levels. Average episodes of nocturnal hypoglycaemia in 8 hours of night-time had a statistically significant negative correlation with the HbA1c levels (correlation coefficient: −0.301, P = 0.034). In addition, low blood glucose index (LBGI) was found to be the best predictor for the risk of hypoglycaemia in 24 hours and nocturnal hypoglycaemia. Conclusion: Various GV indices are associated with HbA1c levels and are better predictors of hypoglycaemia.

Early blood glucose screening in asymptomatic high-risk neonates.

Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity≥35 and <37weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates. All asymptomatic high-risk neonates ≥35weeks gestation underwent early blood glucose screening within thefirst hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association withhypoglycemia risk factors. Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose≤25 mg/dL and≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia. Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.

Prevalence and Risk Factors of Spontaneous Hypoglycemia in Hospitalized Patients: Cross-Sectional Observational Study and Literature Review

Introduction: Spontaneous hypoglycemia is a blood glucose level below 70 mg/dL unrelated to insulin or oral hypoglycemic agents. Objectives: To assess the prevalence of spontaneous hypoglycemia (&lt;70 mg/dL) in adult patients admitted to Hospital Santa Izabel in 2023. Additionally, a narrative review was conducted to evaluate the prevalence, risk factors, main contributing factors, and mortality associated with spontaneous hypoglycemia in hospitalized patients. Methods: A cross-sectional observational study reviewed an electronic medical record database of adult patients. Capillary blood glucose measurements from patients admitted to general wards, intensive care units (ICUs), and emergency services at Hospital Santa Izabel (HSI) in 2023 were analyzed. A narrative review was also performed through a non-systematic PubMed search using the terms hypoglycemia, mortality, hospital, and individuals without diabetes. The search yielded 61 articles, which, along with reference analysis, brought the total to 81 articles. After excluding duplicates and studies irrelevant to the topic, 10 articles were selected for analysis. Results: In 2023, HSI recorded 6,609 episodes of hypoglycemia, accounting for 2.63% of the blood glucose measurements. The prevalence of spontaneous hypoglycemia in the reviewed articles ranged from 0.01% to 0.51%. Spontaneous hypoglycemia occurs more frequently in ICU patients and the elderly. Common risk factors included heart failure, renal failure, malignancy, and pre-existing diabetes. Severe conditions such as cirrhosis, multiple organ failure, polytrauma, and sepsis were also associated with hypoglycemia. Moreover, spontaneous hypoglycemia was linked to higher mortality, with 5 out of 10 studies showing mortality rates 2 to 3 times higher in patients who experienced at least one episode. This association was not commonly observed in insulin-induced hypoglycemia. Conclusion: Spontaneous hypoglycemia in hospitalized patients is a rare event, typically associated with severe acute conditions and advanced age. It is more frequently linked to higher mortality compared to medication-induced hypoglycemia, with mortality rates correlating with the severity of the hypoglycemic episodes.

Meta-analysis of Clinical High-risk Factors for the Development of Neonatal Hypoglycemia

GDM is a common clinical complication of pregnancy, the incidence rate has been increasing in recent years and the risk of neonatal development of neonatal hypoglycemia (NH) has significantly increased. Studies have shown that the incidence of NH in GDM-delivered newborns is up to 27%. Severe hypoglycemia can cause irreversible brain injury and neurological sequelae in newborns, NH is one of the most common metabolic diseases in neonatal intensive care units. However, many scholars have discussed the related risk factors of neonatal hypoglycemia, but the risk factors and research results are different among the studies and there are some controversies. Therefore, this study aims to conduct a Meta-analysis through the domestic and foreign published studies on the risk factors for neonatal hypoglycemia, to identify the main risk factors for neonatal hypoglycemia, and to provide a basis for early clinical prevention and timely development of scientific and effective interventions. Through health and interest Engineering, the computer conducted a literature search in the medical databases of Wanfang Medical, PubMed database, domestic medical research journals, and biomedical medical literature, and conducted a Meta-analysis using Rev Man 5.2 software based on the clinical risk factors of neonatal hypoglycemia. The retrieved literature was screened according to the criteria of study subjects, methods, disease type, and so on, and a total of 9 documents meeting the criteria were finally included, with low bias. The results of the Meta-analysis showed statistical differences in the incidence of pregnant and maternal gestational diabetes, neonatal asphyxia and low birth weight infants in the hypoglycaemic and non-hypoglycaemic neonatal groups, Moreover, the incidence of pregnant and maternal gestational diabetes, neonatal asphyxia, and low birth weight infants was significantly lower in the hypoglycemic neonatal group(P&lt;0.05); Studies evaluated maternal gestational diabetes, neonatal asphyxia and low birth weight infants with neonatal hypoglycemia, The results showed that maternal gestational diabetes, neonatal asphyxia, and low birth weight infants all increase the risk of neonatal hypoglycemia(P&lt;0.001). Therefore, for children with neonatal hypoglycemia, pregnant mothers and gestational diabetes, neonatal asphyxia, and low-weight children are all high-risk factors for hypoglycemia, clinicians should do a good job in prevention and control, and intervention to reduce the incidence of neonatal hypoglycemia.

Dextrose gel prophylaxis for neonatal hypoglycaemia and neurocognitive function at early school age: a randomised dosage trial

ObjectiveTo investigate the effect of different doses of prophylactic dextrose gel on neurocognitive function and health at 6–7 years.DesignEarly school-age follow-up of the pre-hPOD (hypoglycaemia Prevention with Oral Dextrose) study.SettingSchools...

A cross-sectional questionnaire study: Impaired awareness of hypoglycaemia remains prevalent in adults with type 1 diabetes and is associated with the risk of severe hypoglycaemia.

Impaired awareness of hypoglycaemia (IAH) is a risk factor for severe hypoglycaemia (SH) in type 1 diabetes (T1D). Much of the IAH prevalence data comes from older studies where participants did not have the benefit of the latest insulins and technologies. This study surveyed the prevalence of IAH and SH in a tertiary adult clinic population and investigated the associated factors. Adults (≥18 years) attending a tertiary T1D clinic completed a questionnaire, including a Gold and Clarke score. Background information was collected from health records. 189 people (56.1% female) with T1D (median [IQR] disease duration 19.3 [11.5, 29.1] years and age of 41.0 [29.0, 52.0] years) participated. 17.5% had IAH and 16.0% reported ≥1 episode of SH in the previous 12 months. Those with IAH were more likely to report SH (37.5% versus 11.7%, p = 0.001) a greater number of SH episodes per person (median [IQR] 0 [0,2] versus 0 [0,0] P<0.001) and be female (72.7% versus 52.6%, p = 0.036). Socio-economic deprivation was associated with IAH (p = 0.032) and SH (p = 0.005). Use of technology was the same between IAH vs aware groups, however, participants reporting SH were more likely to use multiple daily injections (p = 0.026). Higher detectable C-peptide concentrations were associated with a reduced risk of SH (p = 0.04). Insulin pump and continuous glucose monitor use was comparable in IAH versus aware groups. Despite this, IAH remains a risk factor for SH and is prevalent in females and in older people. Socioeconomic deprivation was associated with IAH and SH, making this an important population to target for interventions.

Neonatal Hypoglycemia and Neurocognitive Function at School Age: A Prospective Cohort Study

To determine the relationship between transient neonatal hypoglycemia in at-risk infants and neurocognitive function at 6-7years of corrected age. The pre-hPOD Study involved children born with at least 1 risk factor for neonatal hypoglycemia. Hypoglycemia was defined as ≥1 consecutive blood glucose concentrations <47mg/dl (2.6mmol/L), severe as <36mg/dl (2.0mmol/L), mild as 36 to <47mg/dL (2.0 to <2.6mmol/L), brief as 1-2 episodes, and recurrent as ≥3 episodes. At 6-7years children were assessed for cognitive and motor function (NIH-Toolbox), learning, visual perception and behavior. The primary outcome was neurocognitive impairment, defined as >1 SD below the normative mean in ≥1 Toolbox tests. The 8 secondary outcomes covered children's cognitive, motor, language, emotional-behavioral, and visual perceptual development. Primary and secondary outcomes were compared between children who did and did not experience neonatal hypoglycemia, adjusting for potential confounding by gestation, birthweight, sex and receipt of prophylactic dextrose gel (pre-hPOD intervention). Secondary analysis included assessment by severity and frequency of hypoglycemia. Of 392 eligible children, 315 (80%) were assessed at school age (primary outcome, n=308); 47% experienced hypoglycemia. Neurocognitive impairment was similar between exposure groups (hypoglycemia 51% vs 50% no hypoglycemia; aRD -4%, 95% CI -15%, 7%). Children with severe or recurrent hypoglycemia had worse visual motion perception and increased risk of emotional-behavioral difficulty. Exposure to neonatal hypoglycemia was not associated with risk of neurocognitive impairment at school-age in at-risk infants, but severe and recurrent episodes may have adverse impacts. Hypoglycemia Prevention in Newborns with Oral Dextrose: the Dosage Trial (pre-hPOD Study): ACTRN12613000322730.

Food Insecurity and Hypoglycemia among Older Patients with Type 2 Diabetes Treated with Insulin or Sulfonylureas: The Diabetes & Aging Study.

Severe hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cooking or shopping for food), which may increase with age, and its association with hypoglycemia. Study associations between food insecurity and severe hypoglycemia. Survey based cross-sectional study. Survey responses were collected in 2019 from 1,164 older (≥ 65years) patients with type 2 diabetes treated with insulin or sulfonylureas. Risk ratios (RR) for economic and physical food insecurity associated with self-reported severe hypoglycemia (low blood glucose requiring assistance) adjusted for age, financial strain, HbA1c, Charlson comorbidity score and frailty. Self-reported reasons for hypoglycemia endorsed by respondents. Food insecurity was reported by 12.3% of the respondents; of whom 38.4% reported economic food insecurity only, 21.1% physical food insecurity only and 40.5% both. Economic food insecurity and physical food insecurity were strongly associated with severe hypoglycemia (RR = 4.3; p = 0.02 and RR = 4.4; p = 0.002, respectively). Missed meals ("skipped meals, not eating enough or waiting too long to eat") was the dominant reason (77.5%) given for hypoglycemia. Hypoglycemia prevention efforts among older patients with diabetes using hypoglycemia-prone medications should address food insecurity. Standard food insecurity questions, which are used to identify economic food insecurity, will fail to identify patients who have physical food insecurity only.

Impact of Charlson Comorbidity Index on in-hospital mortality of patients with hyperglycemic crises: A propensity score matching analysis.

This study was designed to investigate the association between Charlson Comorbidity Index (CCI) and in-hospital mortality and other clinical outcomes among patients with hyperglycemic crises. This retrospective cohort study was conducted using data from electric medical records. A total of 1668 diabetic patients with hyperglycemic crises from six tertiary hospitals met the inclusion criteria. CCI < 4 was defined as low CCI and CCI ≥ 4 was defined as high CCI. Propensity score matching (PSM) with the 1:1 nearest neighbour matching method and the caliper value of 0.02 was used to match the baseline characteristics of patients with high CCI and low CCI to reduce the confounding bias. In-hospital mortality, ICU admission, hypoglycemia, hypokalemia, acute kidney injury, length of stay (LOS), and hospitalisation expense between low CCI and high CCI were compared and assessed. Univariate and multivariate regression were applied to estimate the impact of CCI on in-hospital and other clinical outcomes. One hundred twenty-one hyperglycemic crisis (HC) patients died with a mortality rate of 7.3%. After PSM, compared with low CCI, patients with high CCI suffered higher in-hospital mortality, ICU admission, LOS, and hospitalisation expenses. After multivariate regression, age (aOR: 1.12, 95% confidence interval [CI]: 1.06-1.18, p < 0.001), CCI(aOR: 4.42, 95% CI: 1.56-12.53, p = 0.005), uninsured (aOR: 22.32, 95% CI: 4.26-116.94, p < 0.001), shock (aOR: 10.57, 95% CI: 1.41-79.09, p = 0.022), mechanical ventilation (aOR: 75.29, 95% CI: 12.37-458.28, p < 0.001), and hypertension (aOR: 4.34, 95% CI: 1.37-13.82, p = 0.013) were independent risk factors of in-hospital mortality of HC patients. Besides, high CCI was an independent risk factor for higher ICU Admission (aOR: 5.91, 95% CI: 2.31-15.08, p < 0.001), hypoglycemia (aOR: 2.19, 95% CI:1.01-4.08, p = 0.049), longer LOS (aOR: 1.23, 95% CI: 1.19-2.27, p = 0.021), and higher hospitalisation expense (aOR: 2089.97, 95% CI: 193.33-3988.61, p = 0.031) of HC patients. CCI is associated with in-hospital mortality, ICU admission, hypoglycemia, LOS, and hospitalisation expense of HC patients. CCI could be an ideal indicator to identify, monitor, and manage chronic comorbidities among HC patients.

Diabetes-related hypoglycemia, contributing risk factors, glucagon prescriptions in two community hospitals

IntroductionHypoglycemia has long been recognized as a dangerous adverse effect of the treatment of diabetes mellitus with insulin or insulin secretagogues. ObjectiveOur study was aimed to identify the number of diabetic patients presenting to the emergency department (ED) with hypoglycemia, contributing risk factors for hypoglycemia (including antidiabetic medication regimens), the number of episodes of hypoglycemia requiring medical attention, and how many patients were prescribed glucagon at discharge. Study designOur study is a retrospective analysis across two hospitals from October 2019 to March 2022, including the population of adult persons with diabetes mellitus, above 18 years of age, presenting to the emergency department with hypoglycemia. ResultsOf the women were 2 African Americans, 25 Caucasians, 17 Hispanics, and 39 from other ethnicities. Of the men were 8 African Americans, 32 Caucasians, 27 Hispanics, and 44 from other ethnicities. The mean age of males was 66.2 years, and females was 72.9 years. 131 patients had no prior visits for hypoglycemia. Of the 194 patients, 54 were discharged from the ED, and 140 were admitted to the hospital. The most common risk factors associated with hypoglycemia requiring medical attention were age > 65, having more than one comorbidity, decreased oral intake, and poor socioeconomic status. Regarding recurrent presentations with hypoglycemia, there was a significant association with insulin use (p-value = 0.0007), with a higher-than-expected number of insulin users having a previous visit for hypoglycemia. Only 16.7 % of non-insulin-using patients had prior visits, compared to 40.6 % of insulin users. Pairwise Chi-square testing did not reveal a significant association between any other medication class and prior visits for hypoglycemia, nor was there an association between risk factors and prior visits. To obtain optimal glycemic control, early identification of hypoglycemia risk factors, self-monitoring of blood glucose, and proper selection of anti-diabetic regimens are important to prevent long-term complications. ConclusionUnfortunately, the three elements that would prevent subsequent severe hypoglycemic events (i.e., education, adjustment of medication, and glucagon prescription) are underutilized. Hypoglycemia is more common in the elderly population which remains an unmodifiable risk factor. Identifying patients with persistent poor oral intake is extremely important as they may be prone to hypoglycemic episodes on their current anti-diabetic regimen and will need medication adjustments accordingly. Our future research focuses on whether giving glucagon prescriptions to patients with diabetes mellitus at discharge prevents recurrent ED visits for hypoglycemia.

Development and internal validation of a clinical score to predict neonatal hypoglycaemia in women with gestational diabetes.

Gestational diabetes (GD) is a risk factor for neonatal hypoglycaemia (NH), but other factors can increase this risk. To create a score to predict NH in women with GD. Retrospective study of women with GD with a live singleton birth between 2012 and 2017 from the Portuguese GD registry. Pregnancies with and without NH were compared. A logistic regression was used to study NH predictors. Variables independently associated with NH were used to score derivation. The model's internal validation was performed by a bootstrapping. The association between the score and NH was assessed by logistic regression. We studied 10216 pregnancies, 410 (4.0%) with NH. The model's AUC was 0.628 (95%CI: 0.599-0.657). Optimism-corrected c-index: 0.626. Points were assigned to variables associated with NH in proportion to the model's lowest regression coefficient: insulin-treatment 1, preeclampsia 3, preterm delivery 2, male sex 1, and small-for-gestational-age 2, or large-for-gestational-age 3. NH prevalence by score category 0-1, 2, 3, 4, and ≥5 was 2.3%, 3.0%, 4.5%, 6.0%, 7.4%, and 11.5%, respectively. Per point, the OR for NH was 1.35 (95% CI: 1.27-1.42). A score of 2, 3, 4, 5 or ≥6 (versus ≤1) had a OR for NH of 1.67 (1.29-2.15), 2.24 (1.65-3.04), 2.83 (2.02-3.98), 3.08 (1.83-5.16), and 6.84 (4.34-10.77), respectively. Per each score point, women with GD had 35% higher risk of NH. Those with ≥6 points had 6.8-fold higher risk of NH compared to a score ≤1. Our score may be useful for identifying women at a higher risk of NH.

Association of Fetal Catecholamines With Neonatal Hypoglycemia

Perinatal stress and fetal growth restriction increase the risk of neonatal hypoglycemia. The underlying pathomechanism is poorly understood. In a sheep model, elevated catecholamine concentrations were found to suppress intrauterine insulin secretion, followed by hyperresponsive insulin secretion once the adrenergic stimulus subsided. To determine whether neonates with risk factors for hypoglycemia have higher catecholamine concentrations in umbilical cord blood (UCB) and/or amniotic fluid (AF) and whether catecholamines are correlated with postnatal glycemia. In a prospective cohort study of 328 neonates at a tertiary perinatal center from September 2020 through May 2022 in which AF and UCB were collected immediately during and after delivery, catecholamines and metanephrines were analyzed using liquid chromatography with tandem mass spectrometry. Participants received postnatal blood glucose (BG) screenings. Risk factor for neonatal hypoglycemia. Comparison of catecholamine and metanephrine concentrations between at-risk neonates and control participants, and correlation of concentrations of catecholamines and metanephrines with the number and severity of postnatal hypoglycemic episodes. In this study of 328 neonates (234 in the risk group: median [IQR] gestational age, 270 [261-277] days; and 94 in the control group: median [IQR] gestational age, 273 [270-278] days), growth-restricted neonates showed increased UCB median (IQR) concentrations of norepinephrine (21.10 [9.15-42.33] vs 10.88 [5.78-18.03] nmol/L; P < .001), metanephrine (0.37 [0.13-1.36] vs 0.12 [0.08-0.28] nmol/L; P < .001), and 3-methoxytyramine (0.149 [0.098-0.208] vs 0.091 [0.063-0.149] nmol/L; P = .001). Neonates with perinatal stress had increased UCB median (IQR) concentrations of norepinephrine (22.55 [8.99-131.66] vs 10.88 [5.78-18.03] nmol/L; P = .001), normetanephrine (1.75 [1.16-4.93] vs 1.25 [0.86-2.56] nmol/L; P = .004), and 3-methoxytyramine (0.120 [0.085-0.228] vs 0.091 [0.063-0.149] nmol/L; P = .008) (P < .0083 was considered statistically significant). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were negatively correlated with AF C-peptide concentration (rs = -0.212, P = .005; rs = -0.182, P = .016; and rs = -0.183, P = .016, respectively [P < .017 was considered statistically significant]). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were positively correlated with the number of hypoglycemic episodes (BG concentration of 30-45 mg/dL) (rs = 0.146, P = .01; rs = 0.151, P = .009; and rs = 0.180, P = .002, respectively). Concentrations of UCB metanephrine and 3-methoxytyramine were negatively correlated with the lowest measured BG concentration (rs = -0.149, P = .01; and rs = -0.153, P = .008, respectively). Neonates at risk for hypoglycemia displayed increased catecholamine and metanephrine concentrations that were correlated with postnatal hypoglycemic episodes and lower BG levels; these results are consistent with findings in a sheep model that fetal catecholamines are associated with neonatal β-cell physiology and that perinatal stress or growth restriction is associated with subsequent neonatal hyperinsulinemic hypoglycemia. Improving the pathomechanistic understanding of neonatal hypoglycemia may help to guide management of newborns at risk for hypoglycemia.

Study of Oral Hypoglycemic Agent-induced Hypoglycemia in Type 2 Diabetes Mellitus in a Tertiary Care Center.

Diabetes prevalence is increasing rapidly; estimates from the International Diabetes Federation put the number at 381 million people have diabetes. Hypoglycemia is a commonly encountered complication in diabetic patients, which, in the short-term, can lead to mortality and, in the long-term, precludes maintenance of euglycemic control. Over 65.2 % of patients have reported at least one incidence of severe and nonsevere hypoglycemia when on oral hypoglycemic agents (OHA) at an annual crude incidence density of 35.1 events per year per person. Insulin more commonly causes hypoglycemia than OHA. However, this study was done with the aim of studying the hypoglycemia specifically caused by OHAs-clinical profile of patients, medications causing hypoglycemia, and the outcome. This prospective observational study was conducted in the Department of Medicine at a tertiary care hospital in Western Maharashtra. Data was collected over a period of 18 months from Indoor patients on admission having hypoglycemic symptoms with strip blood sugar levels of <70 and on OHAs. Patients on insulin were excluded from the study. There were 60 patients with hypoglycemia with a mean age of 53.65 years and a higher incidence of hypoglycemia in females, 35 (58.3%) compared to males. There was a statistically significant difference between outcome (i.e., discharged or death) and urine protein-creatinine ratio (UPCR), a deranged liver function, that is, serum albumin, serum glutamic oxaloacetic transaminase (SGOT)/aspartate transaminase, and serum glutamic pyruvic transaminase (SGPT)/alanine transaminase (p < 0.05). However, there was no statistically significant difference between outcome (discharged or death) and mean age, gender, mean duration of diabetes mellitus (DM), GCS scoring, and drug type of study subjects (p > 0.05). The risk factors for hypoglycemia were middle-aged patients. Females are at higher risk of hypoglycemia than men. Hypoglycemia due to OHAs is known to have a recurrence of hypoglycemia due to the long half-life of the drug; however, patients who were hospitalized were well monitored and did not have any recurrence of hypoglycemia. Deranged liver function or raised UPCR have high mortality after OHA-induced hypoglycemia.

Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood

The circumstances under which neonatal hypoglycemia leads to brain damage remain unclear due to a lack of long-term data on the neurodevelopment of affected children. As a result, diagnostic strategies and treatment recommendations are inconsistent. To evaluate whether the occurrence of severe transitional neonatal hypoglycemia (defined as having at least 1 blood glucose measurement of 30 mg/dL or below) is associated with adverse neurodevelopment in midchildhood. This cohort study using neurodevelopmental testing of a retrospectively recruited cohort was conducted at a single-center tertiary hospital in Germany between March 2022 and February 2023. Children with neonatal blood glucose screening data were randomly selected from all births between 2010 and 2015. Frequency matching for sex, birth weight, gestational age, socioeconomic status, and primary risk factors for neonatal hypoglycemia was performed. Children with persistent hypoglycemia diseases or any risk factor for adverse neurodevelopment except hypoglycemia were excluded. Data were analyzed between February 2023 and March 2023. At least 1 neonatal hypoglycemia measurement with blood glucose measuring 30 mg/dL or below vs all measured blood glucose levels above 30 mg/dL during postnatal blood glucose screening starting on the first day of life. Cognitive function measured by full-scale IQ test. Secondary outcomes included standardized scales of motor, visual, and executive functions, and child behavior, each measured at ages 7 to 11 years. A total of 140 children (mean [SD] age 9.1 [1.3] years; 77 male [55.0%]) participated in the study. Children with severe neonatal hypoglycemia had a 4.8 points lower mean full-scale IQ than controls (107.0 [95% CI, 104.0-109.9] vs 111.8 [95% CI, 108.8-114.8]). They showed a 4.9-fold (95% CI, 1.5-15.5) increased odds of abnormal fine motor function and a 5.3-fold (95% CI, 2.1-13.3) increased odds of abnormal visual-motor integration. Significantly higher T scores for attention problems (58.2 [95% CI, 56.1-60.2] vs 54.6 [95% CI, 52.6-56.6]) and attention-deficit/hyperactivity disorder symptoms (58.2 [95% CI, 56.2-60.2] vs 54.7 [95% CI, 52.8-56.7]) were reported by parents. Neonatal hypoglycemia with blood glucose levels of 30 mg/dL or below was associated with an increased risk for suboptimal neurodevelopmental outcomes in midchildhood. These findings imply that treatment strategies should aim to prevent episodes of hypoglycemia at these severely low levels.