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Table 2 Characteristics of patients with hypoglycemia during hospitalization for hyperosmolar hyperglycemic crises

From: Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality

 

Hypoglycemia during any time of hospitalization

Hypoglycemia during the initial intravenous insulin therapy phase

Hypoglycemia during the later subcutaneous insulin therapy phase

Characteristic

No (n = 64)

Yes (n = 106)

P value

No (n = 125)

Yes (n = 45)

P value

No (n = 77)

Yes (n = 86)

P value

Demographics

 Age (years)

66 (57–79)

74 (58–83)

0.140

71 (59–81)

74 (52–84)

0.712

65 (56–79)

74 (59–83)

0.013

 Sex (male)

31 (48.4)

51 (48.1)

0.967

59 (47.2)

23 (51.1)

0.653

41 (53.2)

39 (45.3)

0.314

Metabolic characteristics

 Known diagnosis of any form of diabetes before admission (yes)

42 (65.6)

80 (75.4)

0.167

87 (69.6)

35 (77.7)

0.296

52 (67.5)

65 (75.5)

0.254

 Ambulatory treatment with insulin before admission (yes)

20 (31.2)

55 (51.8)

0.009

51 (40.8)

24 (53.3)

0.147

25 (32.4)

46 (53.4)

0.007

 Diagnosis of type 2 diabetes (yes)

51 (79.6)

74 (69.8)

0.157

95 (76.0)

30 (66.7)

0.224

59 (76.6)

60 (69.7)

0.325

 Body mass index (kg/m2)a

27.3 (24.1–30.8)

25.0 (22.0–28.7)

0.009

26.8 (23.5–31.1)

23.1 (20.4–25.9)

 < 0.001

26.7 (23.3–29.9)

25.1 (22.5–30.1)

0.284

 HbA1c during or before admission (%)b

10.8 (9.3–13.2)

10.6 (9.2–12.6)

0.734

10.5 (9.2–12.8)

11.0 (9.2–12.8)

0.794

11.2 (9.8–13.3)

10.5 (9.2–12.4)

0.228

Biochemical tests on admission

 Serum glucose (mg/dL)

809 (679–992)

840 (684–1017)

0.930

814 (679–994)

866 (686–1044)

0.670

815 (686–993)

824 (671–1006)

0.756

 Serum osmolality (mOsm/kg)

334 (321–354)

326 (319–353)

0.226

328 (319–348)

335 (322–375)

0.055

331 (322–354)

325 (318–344)

0.032

 Estimated glomerular filtration rate (mL/min/1.7 m2)c

29 (21–44)

28 (20–38)

0.684

31 (22–42)

27 (17–37)

0.108

28 (21–45)

31 (22–38)

0.983

 Hypokalemia (yes)d

5 (8.6)

7 (7.2)

0.766

8 (7.2)

4 (9.3)

0.663

7 (9.0)

5 (5.8)

0.440

 Hyperkalemia (yes)d

16 (27.5)

30 (31.2)

0.630

39 (35.1)

7 (16.2)

0.022

19 (24.6)

26 (30.2)

0.383

Comorbidities

 Charlson Comorbidity Index (score points)

4 (2–6)

5 (3–7)

0.012

5 (3–7)

5 (2–7)

0.880

4 (2–6)

5 (4–7)

0.004

 Baseline estimated glomerular filtration rate (mL/min/1.7 m2)e

60 (42–83)

63 (38–82)

0.839

61 (40–82)

66 (38–84)

0.796

63 (43–85)

61 (38–78)

0.464

 Personal history of heart failure (yes)

6 (9.4)

18 (17.0)

0.168

16 (12.8)

8 (17.8)

0.411

9 (11.7)

14 (16.3)

0.401

 Personal history of myocardial infarction (yes)

1 (1.6)

15 (14.2)

0.006

11 (8.8)

5 (11.1)

0.649

4 (5.2)

12 (14.0)

0.061

 Personal history of cerebrovascular accident (yes)f

10 (15.6)

25 (23.6)

0.214

25 (20.0)

10 (22.2)

0.752

12 (15.6)

22 (25.6)

0.117

 Personal history of cancer (yes)

6 (9.4)

14 (13.2)

0.452

16 (12.8)

4 (8.9)

0.485

8 (10.4)

12 (14.0)

0.489

 Probable infection during admission (yes)g

27 (42.1)

63 (59.4)

0.029

64 (51.2)

26 (57.7)

0.448

32 (41.5)

53 (61.6)

0.010

Characteristics of admission

 Hyperosmolar ketoacidosis (yes)h

17 (26.6)

37 (28.3)

0.258

38 (30.4)

16 (35.5)

0.524

23 (29.8)

30 (34.8)

0.495

 ICU admission (yes)

12 (18.7)

18 (16.9)

0.769

22 (17.6)

8 (17.7)

0.979

15 (19.4)

14 (16.2)

0.594

Therapy during hospitalization

 Intravenous insulin dose in the first 24 h of hospitalization (IU/kg)i

1.0 (0.6–1.5)

1.4 (1.0–1.8)

0.030

1.2 (0.7–1.6)

1.5 (1.1–2.1)

0.017

NA

NA

NA

 Subcutaneous insulin dose in the first 24 h of subcutaneous therapy (IU/kg)j

0.6 (0.5–0.8)

0.7 (0.5–1.1)

0.263

NA

NA

NA

0.6 (0.5–0.8)

0.7 (0.5–1.1)

0.008

 Initial intravenous insulin therapy phase duration (hours)

44 (24–71)

50 (39–91)

0.082

46 (24–71)

69 (44–122)

 < 0.001

NA

NA

NA

 Secretagogues (yes)k

1 (1.9)

2 (2.7)

0.790

NA

NA

NA

1 (1.6)

2 (2.3)

0.569

 Antidiabetic agents that are unlikely to cause hypoglycemia (yes)l

24 (47.0)

29 (39.1)

0.382

NA

NA

NA

27 (45.7)

26 (30.2)

0.790

 Systemic corticosteroids (yes)m

14 (21.8)

22 (20.7)

0.862

29 (23.2)

7 (15.5)

0.282

18 (23.3)

15 (17.4)

0.347

Outcomes

 Length of hospital stay (days)

7 (5–11)

9 (6–13)

0.022

8 (5–12)

9 (6–13)

0.220

8 (5–12)

9 (6–14)

0.036

 Mortality during hospitalization (yes)

4 (3.1)

7 (6.6)

0.928

4 (3.2)

7 (15.5)

0.004

2 (2.5)

2 (2.3)

0.911

 1-year mortality (yes)n

15 (27.2)

35 (36.8)

0.231

31 (28.1)

19 (47.5)

0.026

18 (27.2)

25 (32.4)

0.499

 2-year mortality (yes)o

19 (37.3)

42 (46.7)

0.278

38 (36.9)

23 (60.5)

0.012

23 (37.1)

31 (43.1)

0.483

  1. Data are absolute numbers and percentages (within parentheses) or medians and interquartile ranges (within parentheses)
  2. aCalculated only if the height was available in any time, and if the body weight was available during hospitalization. Data available for 120 patients
  3. bPreferably, HbA1c value during hospitalization was used. If not available, the most recent value available in the previous year was used. Data available for 163 patients
  4. cGlomerular filtration rate was estimated by CKD-EPI equation, using the creatinine value on admission
  5. dData available for 154 patients, as 16 patients had serum potassium repeatedly indeterminable due to hemolysis in the admission tests
  6. eBaseline glomerular filtration rate was estimated by CKD-EPI equation, using the most recent creatinine value before admission. Data available for 158 patients
  7. fIncludes strokes and transient ischemic attacks
  8. gProbable infection was defined by the presence of fever or use of antibiotic treatment during hospitalization
  9. hHyperosmolar ketoacidosis (as opposed to pure hyperosmolar hyperglycemic state) was defined by metabolic acidosis (pH ≤ 7.30 and bicarbonate ≤ 18 mEq/L) with positive ketonemia (point-of-care β-hydroxybutyrate ≥ 3 mmol/L or, failing that, ≥ 3 + ketonuria intensity)
  10. iDose of intravenous insulin received in the first 24 h of hospitalization. Data available for 126 patients
  11. jDose of subcutaneous insulin received in the first 24 h of the later subcutaneous insulin therapy phase. Data available for 127 patients
  12. kIncludes sulfonylureas and meglitinides
  13. lIncludes metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 agonists, sodium-glucose cotransporter-2 inhibitors, and thiazolidinediones
  14. mPatients who received at least one dose of any type of oral or intravenous glucocorticoid
  15. nIncludes patients that reached 1 year of follow-up or died before 1 year (n = 150)
  16. oIncludes patients that reached 2 years of follow-up or died before 2 years (n = 141)
  17. ICU intensive care unit, NA not applicable
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Diabetology & Metabolic Syndrome

ISSN: 1758-5996

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