Hypoglycemia is a common, difficult to prevent adverse outcome of inpatient diabetes care, which is associated with increased morbidity, mortality and length of stay. ADA standards of care 2020 recommend institutional adoption of evidence-based hypoglycemia management protocols. However, little data is available assessing the efficacy of common hypoglycemia treatment modalities utilized.
The aim of this retrospective study was to evaluate efficacy and safety of 4 hypoglycemia treatment modalities based on initial blood glucose; 50 ml of D50 (T1), 250 ml of D10 (T2), 25 ml of D50 (T3) and 125 ml of D10(T4). Chart review was done on 4,626 admitted to a tertiary medical center between 6/1/16 - 2/28/17 and 6/1/17 - 2/28/18, with 1 or more episodes of hypoglycemia. Patients included in the analysis were non-pregnant adults treated with insulin or oral glucose lowering agents who needed treatment with IV Dextrose. 618 patients met the inclusion criteria. Comparisons were made between the 4 treatment modalities after adjusting for baseline blood glucose; standard protocols recommend T1 and T2 for ADA level 2 hypoglycemia, vs. T3 and T4 for level 1 hypoglycemia. Mean blood sugars were : 48+/13 (T1), 4 8+/-12 (T2), 60 +/-7 (T3), and 61 +/-6 (T4). A difference in resolution of hypoglycemia at time 1 (a median of 21 minutes after treatment) was noted; 96.8% in T1, 94.5% in T2, 97.3% in T3 and 98.6% in T4 (P<0.0001). At time 2 (a median of 2.3 hours after the treatment), recurrent hypoglycemia was 25.8% in T1, 17.6% in T2, 15% in T3 and 16.5% in T4 (p=0.005). Hyperglycemia (>180 mg/dL) at time 2 was higher in T1 and T2, 11.7% and 11% respectively, compared with 6.3% in T3 and only 2.9% in T4 (P=0.005). 50 ml of D50 was associated with the highest rate of recurrent hypoglycemia. Across all arms, recurrent hypoglycemia was common at 2 hours after initial treatment, with time widely varied (19 minutes to 12 hours). Protocols should include ongoing monitoring after initial hypoglycemia.
M.L. Jones-Ryan: None. N. Addasi: None. J.T. Knezevich: Speaker’s Bureau; Spouse/Partner; Valeritas, Inc. K. Samson: None. A.T. Drincic: None.