Risk factors for hypoglycaemia in non-critical hospitalised diabetic patients

Abstract

Objective

To determine the risk factors for hypoglycaemia in patients with diabetes on general hospital wards based on a systematic review of the literature since 2013 and meta-analysis.

Methods

Systematic review of the literature focused on the conceptual and methodological aspects of the PRISMA Declaration. The search carried out in Pub Med, Web of Science, Medline, Scielo, Lilacs, OVID, grey literature and Google Academic focused on risk factors for hypoglycaemia in patients with diabetes on general hospital wards. The CASPe (Critical Appraisal Skills Programme Spanish) tool was applied for quality control.

Results

From 805 references, 70 potentially eligible articles were identified for review of abstracts and full text. Finally, according to inclusion and exclusion criteria, seven studies with 554,601 patients of Asian, European and North American ethnicity were selected.

A meta-analysis performed using the random effects model found an association between the presence of hypoglycaemia and: the use of insulin (OR 2.89 [95% CI: 1.8−4.5]); the use of long-acting insulin (OR 2.27 [95% CI: 1.8−2.8]) or fast-acting insulin (OR 1.4 [95% CI: 1.18−1.85]); nasogastric tube feeding (OR 1.75 [95% CI: 1.33−2.3]); chronic kidney disease (OR 1.65 [95% CI: 1.14−2.38]); congestive heart failure (OR 1.36 [95% CI: 1.10−1.68]); and elevated levels of glycosylated haemoglobin (OR 1.59 [95% CI: 1.32−1.91]).

Conclusion

The factors associated with the risk of hypoglycaemia in non-critically ill hospitalised patients with type 2 diabetes were: use of any insulin; nasogastric tube feeding; elevated glycosylated haemoglobin levels; history of congestive heart failure; and chronic kidney disease.

Resumen

Objetivo

Determinar los factores de riesgo de hipoglicemia en pacientes diabéticos hospitalizados en servicio general a partir de una revisión sistemática de la literatura y metaanálisis, desde el 2013.

Métodos

Revisión sistemática de la literatura centrada en los aspectos conceptuales y metodológicos de la Declaración PRISMA. La búsqueda realizada en Pub Med, Web of Science, Medline, Scielo, Lilacs, OVID, literatura gris y Google académico se centró en factores de riesgo de hipoglicemia en pacientes diabéticos hospitalizados en servicio general. Se aplicó la herramienta CASPe (Critical Appraisal Skills Programme Español) para control de calidad.

Resultados

A partir de 805 referencias, se identificaron 70 artículos potencialmente elegibles para revisión de resúmenes y texto completo, finalmente de acuerdo a criterios de inclusión y exclusión se seleccionaron 7 estudios con 554.601 pacientes de etnia oriental, europea y norte americana.

Se realizo un meta-análisis usando el modelo de efectos aleatorios, donde se encontró una asociación entre la presencia de hipoglicemia y el uso de insulina (OR 2,89(IC 95%:1,8–4,5)); uso de insulina larga acción (OR 2,27(IC 95%:1,8–2,8)); o de acción rápida (OR 1,4 (IC 95%:1,18–1,85)); alimentación por sonda nasogástrica (OR 1,75(IC 95%:1,33–2,3)); la presencia de enfermedad renal crónica(OR 1,65(IC 95%:1,14–2,38)); Falla cardiaca congestiva (OR 1,36(IC 95%:1,10–1,68)); y los niveles elevados de Hemoglobina glicosilada (OR 1,59(IC 95%:1,32–1,91)).

Conclusión

Los factores asociados con riesgo de hipoglicemia en el paciente diabético tipo 2, hospitalizado no crítico, fueron: uso de cualquier insulina, alimentación por sonda nasogástrica, niveles elevados de hemoglobina glicosilada, antecedente de falla cardiaca congestiva o enfermedad renal crónica.