HYPOGLYCEMIA IN HOSPITALIZED NONDIABETIC OLDER PATIENTS

OBJECTIVES: To analyze the clinical characteristics, associated risk f actors, and outcome of hypoglycemia in nondiabetic hospitalized older patients. DESIGN: A retrospective case control study. PARTICIPANTS: Si xty patients, aged 65 years and older, in the acute medical and geriat ric wards who developed hypoglycemia. A control group was composed of 83 older patients, sex and age matched, in orthopedic and surgery ward s who were undergoing corrective surgery for hip fracture or herniopla sty. MEASUREMENTS: For all patients, data for the following variables were abstracted from the charts: age, sex, degree of hypoglycemia, cli nical presentation of hypoglycemia, number and duration of hypoglycemi a episodes, nutritional state, and blood chemistry analysis. Risk fact ors were defined as nutritional state, heart failure, renal or liver d isease, malignancy, and infection or sepsis. RESULTS: Mean blood gluco se in hypoglycemic cases was 38.9 +/- 7 mg/dL. Symptoms and signs of h ypoglycemia were noted in only 38.4% (23/60) of patients. All identifi ed risk factors except cachexia were found significantly more frequent ly in the hypoglycemic patients than in the control group. Mean total number of risk factors was greater in the hypoglycemic group than in t he control group, 2.97 +/- 1.1 versus 1.64 +/- .8, respectively (P < . 001). In a multivariant logistic model, low plasma albumin level, live r disease, malignancy, and congestive heart failure were significant p redictors of hypoglycemia. In-hospital mortality rate was higher among the hypoglycemic patients, 48% versus 18.1% (P < .001), and was indep endent of the degree of hypoglycemia or the number of hypoglycemic epi sodes. Mortality was correlated significantly with the number of risk factors (3.4 +/- 1.1 vs 2.5 +/- 1.1; P = .006). Hypoglycemia remained a significant predictor of mortality (OR = 3.67; 95% CI, 1.2 - 11.2) e ven after the adjustment for other risk factors. CONCLUSIONS: Hypoglyc emic episodes occur even among nondiabetic hospitalized older patients . Symptoms and signs of hypoglycemia were noted in only two-fifths of the patients. Albumin less than 3.0 g%, liver disease, renal insuffici ency, malignancy, congestive heart failure, and sepsis were statistica lly significant predictors of developing hypoglycemia. The overall mor tality rate was significantly higher among the hypoglycemic patients a nd was independent of hypoglycemia levels. Mean total number of risk f actors was significantly higher among those who died compared with hyp oglycemic patients who survived. Based on the present study, the estim ated odds of mortality in an older patient with hypoglycemia were 3.67 times higher than in those without hypoglycemia.