Robert Ross, PharmD
Clinical Pharmacy Research Fellow
NF/SG VA Health System
Gainesville, Florida
Disclosure information not submitted.
Nichelle Vadakkel
North Florida/South Georgia Veterans Health System
Gainesville, Florida
Disclosure information not submitted.
Kearsten Westmoreland, PharmD
Clinical Pharmacy Specialist
Oklahoma City Veterans Affairs Medical Center, United States
Disclosure information not submitted.
Andy Hendrickson, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System, United States
Disclosure information not submitted.
Julia Balazh, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System, United States
Disclosure information not submitted.
Evan Telford, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System, United States
Disclosure information not submitted.
Andrew Franck, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System, United States
Disclosure information not submitted.
Title: Risk factors for hypoglycemia during the treatment of hyperglycemic crises
Introduction: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening hyperglycemic crises often requiring intensive care unit (ICU) management. Treatment typically includes intravenous (IV) insulin with a transition to subcutaneous (SC) insulin upon resolution. While hypoglycemia is a common complication in the treatment of hyperglycemic crises, risk factors associated with these events have not been well-established. This study aimed to assess for risk factors associated with hypoglycemia during treatment for hyperglycemic crises.
Methods: This case-control study included medical patients admitted to the ICU with hyperglycemic crises at a single Veterans Health System from April 1, 2010 to March 31, 2020. Patients who developed hypoglycemia during hyperglycemic crisis treatment were compared to a control group to assess the odds of developing hypoglycemia based on risk factors including body mass index (BMI), comorbidities, and type of SC insulin used.
Results: Overall, 216 cases of hyperglycemic crises were included. Development of hypoglycemia occurred in 61 cases (44 on SC insulin, 11 on IV insulin, and 6 on both). Odds for hypoglycemia were significantly higher for patients with low BMI [OR 2.82 (1.11-7.18)], type 1 diabetes mellitus (DM) [OR 4.02 (2.09-7.73)], and those resumed on exact chronic SC insulin regimen following hyperglycemic crisis resolution [OR 2.91 (1.06-7.95)]. Odds for hypoglycemia were significantly lower for patients without chronic kidney disease (CKD) [OR 0.52 (0.28-0.95)] and who received insulin glargine or detemir compared to Neutral Protamine Hagedorn (NPH) insulin [OR 0.20 (0.06-0.66)]. No significant differences were seen in the other evaluated variables.
Conclusions: This study found several factors associated with hypoglycemia during treatment of hyperglycemic crises, including low BMI, CKD, type 1 DM, and use of NPH insulin. Many of these factors are not addressed in consensus statement recommendations for management of hyperglycemic crises. Resumption of chronic insulin regimen following resolution of hyperglycemic crisis, a consensus statement recommendation, was found to be associated with increased odds of hypoglycemia. These findings may help ICU clinicians in preventing this common complication of hyperglycemic crises management.