Dataset Information

Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes.

ABSTRACT:

Objective

To determine the association of weight-based insulin dose with hypoglycemia in noncritically ill inpatients with diabetes.

Research design and methods

We performed a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. Patients with glucose levels <70 mg/dL (case subjects) were matched one to one with nonhypoglycemic control subjects on the basis of the hospital day of hypoglycemia, age, sex, and BMI.

Results

Relative to 24-h insulin doses <0.2 units/kg, the unadjusted odds of hypoglycemia increased with increasing insulin dose. Adjusted for insulin type, sliding-scale insulin use, and albumin, creatinine, and hematocrit levels, the higher odds of hypoglycemia with increasing insulin doses remained (0.6-0.8 units/kg: odds ratio 2.10 [95% CI 1.08-4.09], P = 0.028; >0.8 units/kg: 2.95 [1.54-5.65], P = 0.001). The adjusted odds of hypoglycemia were not greater in patients who received 0.2-0.4 units/kg (1.08 [0.64-1.81], P = 0.78) or 0.4-0.6 units/kg (1.60 [0.90-2.86], P = 0.11). Although the relationship between insulin dose and hypoglycemia did not vary by insulin type, patients who received NPH trended toward greater odds of hypoglycemia compared with those given other insulins.

Conclusions

Higher weight-based insulin doses are associated with greater odds of hypoglycemia independent of insulin type. However, 0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low. These findings may help clinicians use insulin more safely.

SUBMITTER: Rubin DJ

PROVIDER: S-EPMC3142056 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Publications

Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes.

Rubin Daniel J DJ Rybin Denis D Doros Gheorghe G McDonnell Marie E ME McDonnell Marie E ME

Diabetes care 20110623 8

<h4>Objective</h4>To determine the association of weight-based insulin dose with hypoglycemia in noncritically ill inpatients with diabetes.<h4>Research design and methods</h4>We performed a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. Patients with glucose levels <70 mg/dL (case subjects) were matched one to one with nonhypoglycemic control subjects on the basis of the hospital day of hypoglycemia, age, sex, and BMI.<h4>Results</h4>Relative to 24-h in ...[more]

PMID: 21700919

Similar Datasets

Project description:BACKGROUND:Although beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied. This study sought to determine the relationship between type of beta blocker and incidence of hypoglycemia and mortality in hospitalized patients. METHODS:We retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose < 3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose < 2.2 mmol/L throughout hospitalization (Hyposevere). RESULTS:There were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p = 0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p = 0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p = 0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients. CONCLUSIONS:Beta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study.

Dataset Information

Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes.

Objective

Research design and methods

Results

Conclusions

Publications

Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes.

Similar Datasets

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