368-P: Identifying Causes and Improving Hypoglycemia in Hospitalized Patients—An Update

Introduction & Objective: Hypoglycemia is known to increase morbidity, mortality, and lengthen hospital stay leading to increased health care costs. The purpose of our study is to investigate the prevalence and identify causes and risk factors contributing to inpatient hypoglycemia. We report findings from two of our largest community hospitals in combination with our previously reported data from a tertiary referral center to better represent the general population.

Methods: We performed a retrospective cross sectional analysis of adult patients 18 years and older who were admitted to two of our community hospitals and had a hypoglycemic event, defined as glucose ≤55 mg/dL. A chart review, during a six month period in 2022 and 2023, was conducted to identify causes and associated comorbidities. We incorporated data from our previously reported tertiary care center findings.

Results: We evaluated 1,928 episodes of hypoglycemia occurring in 1,044 adult patients hospitalized across 3 hospitals. 57% of the patients had diabetes mellitus. Hypoglycemia occurred most frequently due to decreased caloric intake related to critical illness (53%) followed by insulin-induced hypoglycemia (39%). In patients without diabetes, 75% of hypoglycemic events were due to decreased caloric intake and critical illness. Kidney failure (32%), coronary artery disease (20%) and malignancy (15%) were the comorbidities most frequently associated with hypoglycemia.

Conclusion: Hypoglycemic events were most frequently caused by decreased caloric intake and insulin administration. Within the 40% of patients who did not have diabetes, 75% had hypoglycemia due to decreased caloric intake. This sheds light onto a population which has traditionally not been associated with hypoglycemia. Identifying patients at risk for hypoglycemia, improving nutritional status in critically ill patients and optimizing glycemic monitoring/insulin management are areas where intervention can improve inpatient hypoglycemia rates.