In our study of hypoglycemia in hospitalized patients with diabetes (1), we have found a strong association between the frequency and severity of hypoglycemia and clinical outcomes including mortality and length of hospital stay. In their comment, Ng et al. (2) remind us that hypoglycemia as a clinical event is characterized not only by the blood glucose level but also by its duration. As expected, longer duration of hypoglycemia is associated with adverse outcomes (3). Previously published studies have shown that higher staffing levels in the hospitals are associated with better care (4), including lower rates of “failure to rescue” patients from critical events such as cardiac arrest, shock, or gastrointestinal bleeding. The report by Ng et al. provides evidence that improvement in care as a result of better nurse staffing extends to the treatment of hypoglycemia. Their findings lend further support to the importance of adequate levels of health care personnel to the quality of treatment of hospitalized patients.
Acknowledgments
This study was supported in part by grants from the Diabetes Action Research and Education Foundation (to A.T.) and the National Library of Medicine (to M.E.M.).
No potential conflicts of interest relevant to this article were reported.
