Hypoglycemic episodes in hospitalized people with diabetes in Portugal: the HIPOS-WARD study

Alão, Sílvia; Conceição, João; Dores, Jorge; Santos, Lèlita; Araújo, Francisco; Pape, Estevão; Reis, Mónica; Chipepo, Árcia; Nascimento, Edite; Baptista, Ana Catarina; Pires, Vanessa; Marques, Carlos; Lages, Adriana D S; Pelicano-Romano, João; de Jesus, Paula M

http://hdl.handle.net/10400.1/15041

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Authors

Alão, Sílvia

Conceição, João

Dores, Jorge

Santos, Lèlita

Araújo, Francisco

Pape, Estevão

Reis, Mónica

Chipepo, Árcia

Nascimento, Edite

Baptista, Ana Catarina

Abstract(s)

Background We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. Methods In this cross-sectional, multicentered study, the observational data was collected by physicians from patient’s hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. Results There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). Conclusions Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.