SHM Converge Scientific Abstract ePoster Gallery-Hypoglycemia in Hospitalized Diabetic Patients With End-Stage Renal Disease

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This retrospective cohort study examined hospitalized patients with diabetes and end-stage renal disease (ESRD) across 186 HCA Healthcare hospitals from July 2020 to June 2022. Among 10,388 encounters, 1,499 (14.44%) had hypoglycemia, with 56.2% classified as hypoglycemia, 27.5% as significant hypoglycemia, and 16.3% as severe hypoglycemia. Episodes occurred most often in the morning (35.89%), followed by nighttime (29.29%), afternoon (25.48%), and evening (9.34%).<br /><br />The study aimed to characterize risk factors for inpatient hypoglycemia in this high-risk population. Severe hypoglycemia was associated with higher short-acting insulin doses on the day of the event, higher glargine doses on the prior day, sepsis, and a higher Elixhauser comorbidity index. Age, sex, and BMI were not strong predictors, though BMI was statistically associated with lower odds in the regression model. The model performed well, with a c-statistic of 0.88.<br /><br />The findings suggest that some hypoglycemia may result from overcorrection of elevated glucose levels using insulin doses that do not adequately account for reduced renal function. Patients with hypoglycemia also had higher glucose values overall, supporting this concern. The authors note that insulin needs are often lower in patients with impaired kidney function, yet default inpatient insulin orders may not reflect this.<br /><br />In response, the team implemented an EHR text reminder during glargine ordering to alert clinicians that ESRD patients are at increased risk for hypoglycemia and may need lower doses. They are also developing reduced-dose sliding scale insulin orders for ESRD patients. The goal is to reduce inpatient hypoglycemia and improve patient safety.

Asset Subtitle

Brian Sangalang

Meta Tag

Author List Brendon Cornett, Brian Sangalang, Scott Kubomoto, Yolanda Zhang

Category Research

Concept Hypoglycemia

Concept End-stage Kidney Disease

Concept Severe Hypoglycemia

Concept Insulin Dose

Concept Hospitalized Patient

Distinguished Non-Finalist

Presenter Organization University of California, Riverside - School of Medicine

Presenting Author Brian Sangalang

Track Patient Safety

Keywords

diabetes

end-stage renal disease

inpatient hypoglycemia

hospitalized patients

insulin dosing

glargine

severe hypoglycemia

risk factors

electronic health record reminder

patient safety

Hypoglycemia

End-stage Kidney Disease

Severe Hypoglycemia

Insulin Dose

Hospitalized Patient