Materiały źródłowe

• #1 Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2699723/

  Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. […] In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward. […] Hypoglycemia was observed in 7.7% of admissions. In multivariable analysis, each additional day with hypoglycemia was associated with an increase of 85.3% in the odds of inpatient death (P = 0.009) and 65.8% (P = 0.0003) in the odds of death within 1 year from discharge. […] The odds of inpatient death also rose threefold for every 10 mg/dl decrease in the lowest blood glucose during hospitalization (P = 0.0058). […] LOS increased by 2.5 days for each day with hypoglycemia (P 0.0001). […] Patients with hypoglycemia have increased LOS and higher mortality both during and after admission.

• #2 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  Hypoglycemia requires immediate treatment by eating or drinking sugar/carbohydrates. Severe hypoglycemia can be life-threatening and requires treatment with emergency glucagon and/or medical intervention. […] Severe hypoglycemia is life-threatening. It needs immediate medical treatment. In rare cases, severe hypoglycemia that isn’t treated can result in a coma and/or death. […] Prolonged severe hypoglycemia is life-threatening and can lead to the following complications: Multiple organ failure, Cardiac arrhythmias, Cardiac arrest, Permanent brain damage, Coma, Death. […] The prognosis (outlook) of non-diabetes-related hypoglycemia varies depending on the underlying cause. Having frequent hypoglycemia episodes can be dangerous if you have diabetes. It can lead to hypoglycemia unawareness, which means you don’t experience warning signs of low blood sugar. It’s important to see a healthcare provider who helps you manage diabetes if you’re having frequent lows.

• #3 Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2699723/

  Mortality 1 year after discharge was 27.8% for patients who had at least one hypoglycemic episode vs. 14.1% for patients who had no hypoglycemic episodes (P 0.0001). […] Multivariable analysis of this dataset showed a 65.8% increase in mortality 1 year after discharge for each day with a hypoglycemic episode during the admission (P = 0.0003). […] In multivariable analysis, the odds of inpatient mortality increased threefold for every 10 mg/dl decrease in the lowest blood glucose (P = 0.0058). […] In a multivariable analysis adjusted for the patients’ demographics, expected LOS, Charlson Comorbidity Index, diabetes complications, GFR, and average blood glucose, the actual length of stay increased by 2.5 days compared with the average for the DRG for each additional day with a hypoglycemic episode (P 0.0001). […] In summary, hypoglycemia in diabetic patients hospitalized in the general ward was associated with increased inpatient and postdischarge mortality as well as with a prolonged LOS.

• #4

  https://link.springer.com/article/10.1007/s00125-020-05366-3

  Hypoglycaemia has been recognised as a complication of insulin treatment from the very first days of the discovery of insulin, and remains a major concern for people with diabetes, their families and healthcare professionals today. […] There are long-term consequences of recurrent hypoglycaemia, which are still not fully understood. […] The common outcome of any hypoglycaemic episode is complete recovery, but we have already begun to allude to possible impacts of hypoglycaemia on future health. […] There is a growing body of evidence linking severe hypoglycaemia to future mortality both in hospital and in the community, with estimates of increased risk ranging from 50% to 600%. […] Severe hypoglycaemia has been associated with approximately a doubling in risk of subsequent cardiovascular events, including death, but the relationship is bi-directional.

• #5 Development of a model to predict 5-year risk of severe hypoglycemia in patients with type 2 diabetes | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/6/1/e000527

  We constructed a predictive model of long-term risk for severe hypoglycemia (SH: hypoglycemia requiring assistance) in patients with type 2 diabetes (T2DM). […] Using this information, we derived point scores to estimate the 5-year risk for SH in individual patients with T2DM. […] After adjusting for other variables in the model, the three strongest predictors for SH over 5 years were intensive glycemic management (HR=2.37, 95%CI 1.99 to 2.83), insulin use (HR=2.14, 95% CI 1.77 to 2.59), and antihypertensive medication use (HR=1.90, 95% CI 1.26 to 2.86). […] Using the ACCORD data, we identified attributes to predict 5-year risk of SH in patients with T2DM, which warrant evaluation in broader populations to determine applicability. […] Currently, we lack a systematic method to predict the long-term SH risk in patients with T2DM.

• #6 Development of a model to predict 5-year risk of severe hypoglycemia in patients with type 2 diabetes | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/6/1/e000527

  The final model for the prediction of SH included intensive glycemic management, age, race, education, insulin use, antihypertensive medication use, years since diabetes diagnosis, history of hypoglycemia in the last week, SBP, DBP, waist circumference, serum creatinine and UACR, HMG-CoA reductase inhibitors, and non-insulin diabetes medications (sulfonylurea, biguanide, and meglitinide). […] The c-statistic for the final Cox regression model was 0.782. […] Point scores were created directly from the Cox regression model to improve the utility of the predictive model. […] By estimating the long-term SH risk for an individual with T2DM, these findings, after further validation with future studies, may provide additional critical information that could change clinical practice. […] Our findings demonstrate that certain baseline clinical features enhance the long-term risk for SH.

• #7 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  There are many misconceptions about the prevalence and effects of hypoglycemia in people with type 2 diabetes (T2D), including hypoglycemia does not occur or does not have adverse consequences in T2D. […] Recent evidence suggests serious consequences of hypoglycemia may, in some respects, be greater in individuals with T2D, particularly regarding effects on the cardiovascular system. […] The risk of hypoglycemia in people with T2D has been considered less important, with the implication that it can often be ignored. […] The group with T2D taking insulin for over 5 years had a significantly higher risk of severe hypoglycemia, with around 25% reporting a severe hypoglycemic episode during the study. […] It is beyond the scope of this review to give a detailed account of the consequences of hypoglycemic episodes, but recent trials have raised the possibility that, in addition to the well-recognized effects of hypoglycemia on the central nervous system, hypoglycemia may also have adverse consequences on the cardiovascular system.

• #8 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  The current debate is focused on whether hypoglycemia is a risk factor, implying causality or merely a risk marker such that hypoglycemia is more common in vulnerable individuals due to frailty and comorbidity. […] The strength and consistency of the association reinforces the importance of choosing treatment which minimizes the risk of hypoglycemia, particularly in vulnerable individuals. […] Hypoglycemia has been found to contribute to cardiovascular and central nervous system harm in people with T2D. […] Hypoglycemia is a risk for people with T2D being treated with insulin, with reported rates of severe hypoglycemia around 2.5 events per person per year. […] An improved understanding of the barriers to accurate reporting would assist the diabetes community in estimating the frequency and severity of hypoglycemic episodes in people with T2D. […] Consistent clinical study designs that use standardized hypoglycemia reporting levels and definitions of time-in-range goals will contribute to the accurate assessment of hypoglycemic risk in people with T2D.

• #9 Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/122122-overview

  The prognosis of hypoglycemia depends on the cause of this condition, its severity, and its duration. If the cause of fasting hypoglycemia is identified and treated early, the prognosis is excellent. If the problem is not curable, such as an inoperable malignant tumor, the long-term prognosis is poor. However, note that these tumors may progress rather slowly. Severe and prolonged hypoglycemia can be life threatening and may be associated with increased mortality in patients with diabetes. […] If the patient has reactive hypoglycemia, symptoms often spontaneously improve over time, and the long-term prognosis is very good. Reactive hypoglycemia is often treated successfully with dietary changes and is associated with minimal morbidity. Mortality is not observed. Untreated reactive hypoglycemia may cause significant discomfort to the patient, but long-term sequelae are not likely. […] A study by Boucai et al found that drug-associated hypoglycemia was not associated with increased mortality risk among patients admitted to general wards. This suggests that hypoglycemia may be a marker of disease burden and not a direct cause of death.

• #10

  https://link.springer.com/article/10.1007/s00125-020-05366-3

  Hypoglycaemia has been a complication of diabetes treatments since the discovery of insulin, and remains a major concern for people with diabetes, their families and friends, and healthcare professionals and providers. Experiencing hypoglycaemia has consequences, as summarised in Fig. 1. Individual episodes of hypoglycaemia are inconvenient, unpleasant and potentially dangerous and recurrent episodes have long-term negative health implications that are still being explored.

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