Hypoglycemia in Diabetic Patients on Hemodialysis: A Significant Problem During Admission

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 281-289-Endocrine Healthcare Delivery, Education & Outcomes
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-289
Tara Kim*1, Alyson K Myers2, Ann Marie Hasse3 and Tracy Lynn Breen4
1North Shore LIJ Health System, Manhasset, NY, 2North Shore Long Island Jewish Health System, Manhasset, NY, 3North Shore University Hospital, Manhasset, NY, 4North Shore LIJ Health System, New Hyde Park, NY
There is a growing concern regarding potential harm associated with hypoglycemia among patients admitted to the hospital, particularly in vulnerable populations with multiple co-morbidities, such as end-stage renal disease (ESRD). Insulin and oral secretagogues can cause hypoglycemia, which can worsen with concomitant renal impairment. At North Shore University Hospital (an 804 bed tertiary hospital in the North Shore LIJ Health System), we performed a retrospective chart review on a cohort of inpatients with diabetes (DM) and ESRD who received hemodialysis (HD) between 3/1/2012-5/15/2012 to examine rates of hypoglycemia in that group vs. institutional rates. During this time, the event rate of hypoglycemia (defined as point of care blood glucose less than 70 mg/dL) among all adult inpatients was 1.7% whereas the event rate on the unit where HD occurs was 2.2%.  We found that within our cohort of DM patients on HD (n= 30), the incidence of hypoglycemia was 30%.  Moreover, our results found that while 6.7% of DM patients on HD had a single episode of hypoglycemia, 23.5% of patients had multiple episodes.  The average rate of hypoglycemia per DM patient on HD was 3.2 (SD +5.43) episodes per month.  Of note, within our DM on HD cohort, multiple different diabetes treatment modalities were used, including SQ basal insulin, SQ correctional scale insulin, and oral anti-diabetic medications. While there are published guidelines regarding general principles of inpatient diabetes management (1) there are few studies regarding optimal inpatient strategies for this specific patient population.  In response to the high incidence of hypoglycemia in this cohort, our Inpatient Diabetes Team (full time endocrinologist, nurse practitioner and certified diabetes educator) began rounding regularly on the unit where HD occurs and assessed each patient with DM for recent measurement of HgA1C, diabetes self-management training and glycemic control.  Didactic teaching sessions were also provided to MD, NP and RN staff. Subsequently, the hypoglycemia event rate on the unit where HD occurs decreased from 2.2% (3/1/2012 and 5/15/2012) to 1.7% (9/1/2012-11/1/2012).  Most institutions have limited resources to address the challenges associated with a high prevalence of DM among inpatients.  This study highlights an opportunity to specifically examine high-risk subgroups (such as diabetic patients on HD) in order to better triage interventions towards vulnerable patient populations.

(1) Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, Seley JJ, Van den Berghe G; Endocrine Society. J Clin Endocrinol Metab. 2012 Jan;97(1):16-38. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline.

Nothing to Disclose: TK, AKM, AMH, TLB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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