Spotlight on hospitalized patients with diabetes

Multiple recent studies focused on hyper- and hypoglycemia among hospitalized patients.

The first study, published by the Journal of Clinical Endocrinology and Metabolism on Nov. 17, investigated the association between spontaneous and insulin-related hypoglycemia and mortality in hospitalized patients in Israel. The cohort study included 33,675 patients, of whom 2,605 had moderate hypoglycemia (a glucose value of 40 to 70 mg/dL [2.2 to 3.9 mmol/L]) and 342 had severe hypoglycemia (a glucose value <40 mg/dL [2.2 mmol/L]) during hospitalization. Over a median follow-up of over 2 years, mortality was higher among patients with any type of hypoglycemia than among those without. The mortality risk was highest among those with severe hypoglycemia, whether insulin-related or not. Among patients with moderate hypoglycemia, mortality risk was higher among those who had received insulin than among those who hadn't. The authors noted a number of possible explanations for the findings: Hypoglycemia could lead directly to death, could be a marker of greater illness severity, or could lead to higher glucose targets, which result in more metabolic complications.

The second study, published by Diabetes Care on Nov. 29, looked at the relationship between hyperglycemia and sleep in hospital patients. The retrospective analysis included 212 patients, 73 of whom had diabetes, and measured sleep duration and efficiency using wrist actigraphy. Each additional hour of sleep during a night in the hospital was associated with 11% lower proportional odds of being in a higher glucose category the next morning (hyperglycemia vs. elevated vs. normal). Every 10% increase in sleep efficiency was associated with 18% lower odds of being in a higher glucose category. This study is the first to report an association between shorter inpatient sleep and higher glucose levels, the authors said. However, because it was an observational study, causality cannot be assumed, and confirmatory research is needed. If the association were found to be causal, interventions to improve inpatient sleep could be tried to reduce the risk of hyperglycemia, the authors concluded.

A third study, published in the December Diabetologia, assessed the effects of corticosteroids in inpatients with community-acquired pneumonia (CAP) and diabetes. It was a preplanned subanalysis of a trial that randomized CAP patients in Switzerland to 50 mg of prednisone for 7 days or placebo. Of the 726 patients treated under the study protocol, 19% had diabetes. The analysis found that the prednisone group had shorter time to clinical stability regardless of whether they had diabetes. Prednisone was associated with glycemic dysregulation, but this did not translate into worse clinical outcomes, leading the study authors to find “the risk of diabetes progression due to a short-term corticosteroid intervention in the diabetic population to be negligible.” Based on the results, they advocated appropriate use of corticosteroids for CAP patients with diabetes or hyperglycemia on admission. The results should also lead clinicians to reconsider how aggressively they treat transient steroid-induced hyperglycemia, according to an accompanying commentary.