From: Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality
Hypoglycemia during any time of hospitalization | Hypoglycemia during the initial intravenous insulin therapy phase | Hypoglycemia during the later subcutaneous insulin therapy phase | |||||||
---|---|---|---|---|---|---|---|---|---|
Characteristic | No (n = 64) | Yes (n = 106) | P value | No (n = 125) | Yes (n = 45) | P value | No (n = 77) | Yes (n = 86) | P value |
Demographics | |||||||||
Age (years) | 66 (57–79) | 74 (58–83) | 0.140 | 71 (59–81) | 74 (52–84) | 0.712 | 65 (56–79) | 74 (59–83) | 0.013 |
Sex (male) | 31 (48.4) | 51 (48.1) | 0.967 | 59 (47.2) | 23 (51.1) | 0.653 | 41 (53.2) | 39 (45.3) | 0.314 |
Metabolic characteristics | |||||||||
Known diagnosis of any form of diabetes before admission (yes) | 42 (65.6) | 80 (75.4) | 0.167 | 87 (69.6) | 35 (77.7) | 0.296 | 52 (67.5) | 65 (75.5) | 0.254 |
Ambulatory treatment with insulin before admission (yes) | 20 (31.2) | 55 (51.8) | 0.009 | 51 (40.8) | 24 (53.3) | 0.147 | 25 (32.4) | 46 (53.4) | 0.007 |
Diagnosis of type 2 diabetes (yes) | 51 (79.6) | 74 (69.8) | 0.157 | 95 (76.0) | 30 (66.7) | 0.224 | 59 (76.6) | 60 (69.7) | 0.325 |
Body mass index (kg/m2)a | 27.3 (24.1–30.8) | 25.0 (22.0–28.7) | 0.009 | 26.8 (23.5–31.1) | 23.1 (20.4–25.9) | < 0.001 | 26.7 (23.3–29.9) | 25.1 (22.5–30.1) | 0.284 |
HbA1c during or before admission (%)b | 10.8 (9.3–13.2) | 10.6 (9.2–12.6) | 0.734 | 10.5 (9.2–12.8) | 11.0 (9.2–12.8) | 0.794 | 11.2 (9.8–13.3) | 10.5 (9.2–12.4) | 0.228 |
Biochemical tests on admission | |||||||||
Serum glucose (mg/dL) | 809 (679–992) | 840 (684–1017) | 0.930 | 814 (679–994) | 866 (686–1044) | 0.670 | 815 (686–993) | 824 (671–1006) | 0.756 |
Serum osmolality (mOsm/kg) | 334 (321–354) | 326 (319–353) | 0.226 | 328 (319–348) | 335 (322–375) | 0.055 | 331 (322–354) | 325 (318–344) | 0.032 |
Estimated glomerular filtration rate (mL/min/1.7 m2)c | 29 (21–44) | 28 (20–38) | 0.684 | 31 (22–42) | 27 (17–37) | 0.108 | 28 (21–45) | 31 (22–38) | 0.983 |
Hypokalemia (yes)d | 5 (8.6) | 7 (7.2) | 0.766 | 8 (7.2) | 4 (9.3) | 0.663 | 7 (9.0) | 5 (5.8) | 0.440 |
Hyperkalemia (yes)d | 16 (27.5) | 30 (31.2) | 0.630 | 39 (35.1) | 7 (16.2) | 0.022 | 19 (24.6) | 26 (30.2) | 0.383 |
Comorbidities | |||||||||
Charlson Comorbidity Index (score points) | 4 (2–6) | 5 (3–7) | 0.012 | 5 (3–7) | 5 (2–7) | 0.880 | 4 (2–6) | 5 (4–7) | 0.004 |
Baseline estimated glomerular filtration rate (mL/min/1.7 m2)e | 60 (42–83) | 63 (38–82) | 0.839 | 61 (40–82) | 66 (38–84) | 0.796 | 63 (43–85) | 61 (38–78) | 0.464 |
Personal history of heart failure (yes) | 6 (9.4) | 18 (17.0) | 0.168 | 16 (12.8) | 8 (17.8) | 0.411 | 9 (11.7) | 14 (16.3) | 0.401 |
Personal history of myocardial infarction (yes) | 1 (1.6) | 15 (14.2) | 0.006 | 11 (8.8) | 5 (11.1) | 0.649 | 4 (5.2) | 12 (14.0) | 0.061 |
Personal history of cerebrovascular accident (yes)f | 10 (15.6) | 25 (23.6) | 0.214 | 25 (20.0) | 10 (22.2) | 0.752 | 12 (15.6) | 22 (25.6) | 0.117 |
Personal history of cancer (yes) | 6 (9.4) | 14 (13.2) | 0.452 | 16 (12.8) | 4 (8.9) | 0.485 | 8 (10.4) | 12 (14.0) | 0.489 |
Probable infection during admission (yes)g | 27 (42.1) | 63 (59.4) | 0.029 | 64 (51.2) | 26 (57.7) | 0.448 | 32 (41.5) | 53 (61.6) | 0.010 |
Characteristics of admission | |||||||||
Hyperosmolar ketoacidosis (yes)h | 17 (26.6) | 37 (28.3) | 0.258 | 38 (30.4) | 16 (35.5) | 0.524 | 23 (29.8) | 30 (34.8) | 0.495 |
ICU admission (yes) | 12 (18.7) | 18 (16.9) | 0.769 | 22 (17.6) | 8 (17.7) | 0.979 | 15 (19.4) | 14 (16.2) | 0.594 |
Therapy during hospitalization | |||||||||
Intravenous insulin dose in the first 24 h of hospitalization (IU/kg)i | 1.0 (0.6–1.5) | 1.4 (1.0–1.8) | 0.030 | 1.2 (0.7–1.6) | 1.5 (1.1–2.1) | 0.017 | NA | NA | NA |
Subcutaneous insulin dose in the first 24 h of subcutaneous therapy (IU/kg)j | 0.6 (0.5–0.8) | 0.7 (0.5–1.1) | 0.263 | NA | NA | NA | 0.6 (0.5–0.8) | 0.7 (0.5–1.1) | 0.008 |
Initial intravenous insulin therapy phase duration (hours) | 44 (24–71) | 50 (39–91) | 0.082 | 46 (24–71) | 69 (44–122) | < 0.001 | NA | NA | NA |
Secretagogues (yes)k | 1 (1.9) | 2 (2.7) | 0.790 | NA | NA | NA | 1 (1.6) | 2 (2.3) | 0.569 |
Antidiabetic agents that are unlikely to cause hypoglycemia (yes)l | 24 (47.0) | 29 (39.1) | 0.382 | NA | NA | NA | 27 (45.7) | 26 (30.2) | 0.790 |
Systemic corticosteroids (yes)m | 14 (21.8) | 22 (20.7) | 0.862 | 29 (23.2) | 7 (15.5) | 0.282 | 18 (23.3) | 15 (17.4) | 0.347 |
Outcomes | |||||||||
Length of hospital stay (days) | 7 (5–11) | 9 (6–13) | 0.022 | 8 (5–12) | 9 (6–13) | 0.220 | 8 (5–12) | 9 (6–14) | 0.036 |
Mortality during hospitalization (yes) | 4 (3.1) | 7 (6.6) | 0.928 | 4 (3.2) | 7 (15.5) | 0.004 | 2 (2.5) | 2 (2.3) | 0.911 |
1-year mortality (yes)n | 15 (27.2) | 35 (36.8) | 0.231 | 31 (28.1) | 19 (47.5) | 0.026 | 18 (27.2) | 25 (32.4) | 0.499 |
2-year mortality (yes)o | 19 (37.3) | 42 (46.7) | 0.278 | 38 (36.9) | 23 (60.5) | 0.012 | 23 (37.1) | 31 (43.1) | 0.483 |