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Renal impairment, comorbid conditions prolong length of stay in patients with severe hypoglycaemia

Tristan Manalac
18 Jul 2019
Explanation of personalized diabetes report at the CUHK Yao Chung Kit Diabetes Assessment Centre

Comorbidities, poorer kidney function and recurrent hypoglycaemia episodes increase length of stay (LOS) in patients admitted for severe hypoglycaemia, according to a recent Singapore study.

“Our study has … highlighted several factors that are easily measured that can aid in predicting the LOS in patients admitted with severe hypoglycaemia,” said researchers. “Interventions which address the factors associated with prolonged LOS should reduce the LOS and improve the care of these patients should they be admitted.”

In 304 patients (mean age, 70.6±11.3 years; 40.5 percent male), the mean glycated haemoglobin concentration at baseline was 6.9±1.3 percent. Participants were admitted at the Singapore General Hospital and had had diabetes for a mean of 13.4±8.6 years. Those who passed away during the study period were excluded. [Endocrinol Diabetes Metab 2019;2:e00062]

The median LOS was 3 days. Participants were divided into two: those who fell above (n=131; mean age, 71.9±12.0 years; 40.5 percent male) or below (n=173; mean age, 69.6±10.6 years; 40.5 percent male) the median LOS.

Those in the former group scored significantly higher on the Charlson Comorbidity Index (CCI; 4.9±2.1 vs 4.1±2.1; p=0.001), experienced significantly more recurring hypoglycaemic episodes (38.9 percent vs 27.7 percent; p=0.04) and had significantly more white blood cells upon admission (11.1±4.8 vs 9.3±3.2 ×109/L; p<0.01).

On the other hand, albumin concentrations at admission were significantly lower in those with longer LOS (32.9±6.6 vs 36.8±4.9 g/L; p<0.01). Renal impairment, as indicated by significantly reduced glomerular filtration rates (GFR), was also more severe in the former group (34.6±31.4 vs 44.8±28.9 mL/min).

Bivariate analyses confirmed the above trends. For instance, each point increase in CCI scores corresponded to a significant 11.3-percent (95 percent CI, 4.2–18.9; p<0.01) increase in hospital LOS. A similar effect was observed with each unit increment in white blood cell count (change in LOS, 6.5 percent; 3.5–9.5; p<0.01).

Each point increase in GFR and admission albumin levels had the opposite effect, eliciting a –1.0-percent (–1.7 to –0.4) and –5.7-percent (–7.3 to –4.2; p<0.01 for both) change in hospital LOS, respectively.

“To the best of our knowledge, there are no studies which have examined the factors associated with the LOS of patients with diabetes who have been admitted with severe hypoglycaemia,” said researchers, though some limitations warrant consideration.

Chiefly, the failure to account for other factors that may have affected LOS, such as the complexities of the specific clinical cases and other social factors, may have skewed the results in a particular direction, they said.

Regardless, “this study may confirm the observations of many physicians on the ground using an evidence‐based approach,” said researchers. “Our study adds new knowledge and understanding of the factors that contribute to a prolonged LOS in patients admitted with severe hypoglycaemia,” they said.

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