Introduction: The glycemic target for patients with diabetes in non-critical care hospitalization has not been well studied. The primary objective of this study is to determine the association between glycemic control during hospitalization and adverse events. The secondary objective is to assess the association between hypoglycemia and adverse events.
Methods: We conducted a retrospective cohort study of patients with diabetes hospitalized on medicine wards from 2015 to 2018 in a tertiary care teaching hospital. Exposure was the average glycemia in the first 4 days of hospitalization, categorized into: ≥ 4.0 and ≤ 7.0 mmol/L (tight control),> 7 and ≤ 10.0 mmol/L (loose control, reference group), > 10.0 mmol/L (poor control). Hypoglycemia was defined as any glycemia< 4 mmol/L. Primary outcome was a composite of adverse events, including infection, thromboembolic events, acute kidney injury, and mortality. Logistic regression models were used to assess the relationship between glycemic control and the primary composite outcome.
Results: A total of 1368 patients were included; 407 adverse events were recorded. Compared to loose glycemic control, tight and poor glycemic control was not associated with increased adverse events (tight control adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.63-1.23; poor control adjusted OR: 0.98, 95% CI 0.75-1.28). Any occurrence of hypoglycemia during hospitalization was associated with increased adverse events (adjusted OR 1.85, 95% CI 1.31-2.60).
Conclusion: Tight and poor glycemic control during hospitalization was not associated with increased adverse events compared to loose glycemic control. The result for poor glycemic control was unexpected and may be due to lack of significant difference between the average glycemia in loose and poor glycemic control groups. Hypoglycemia was associated with increased adverse events, suggesting the importance of hypoglycemia prevention during hospitalization.
L. Deng: None. W. Aibibula: None. Z. Talat: None. K.B. Filion: None. S. Eintracht: None. K. Dasgupta: None. V. Tagalakis: None. A. Majdan: Advisory Panel; Self; Abbott, Insulet Corporation. Consultant; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Lilly Diabetes, Sanofi-Aventis. O. Yu: None.