Relative Hypoglycemia is Associated with Delirium in Critically Ill Patients with Diabetes: A Cohort Study

Abstract

Purpose

Critically ill patients with premorbid diabetes can suffer from relative hypoglycemia (RHG), falling below the normal blood glucose (BG) target. However, these events have not been well defined or studied. In the present study, we aimed to explore the incidence and clinical significance of RHG events in critically ill patients with diabetes.

Patients and methods

Patients with a history of diabetes who stayed in the intensive care unit (ICU) for more than three days with at least 12 BG recordings were retrospectively included in the study. A BG level > 30% below the estimated average according to patient hemoglobin A1c measured at admission was defined as a single RHG event. Outcomes were compared between patients with and those without RHG events.

Results

In total, 113 patients were included in the final analysis. RHG was detected in 73 patients (64.6%). Those who experienced RHG events had a significantly higher incidence of ICU delirium. They also had a higher risk of 28-day mortality, but this was not statistically significant. However, patients with a higher frequency of RHG events did have a significantly higher risk of overall mortality (57.1% for more than four events vs 15.4% for three to four events, P=0.006 and 15.1% for one to two events, P=0.003).

Conclusion

In conclusion, RHG is a common finding in critically ill patients with diabetes and is associated with mortality and the occurrence of delirium.

Keywords:

• relative hypoglycemia
• delirium
• diabetes
• intensive care unit patients

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from corresponding authors on reasonable request.

Ethics Approval and Informed Consent

The study was approved by the ethics committee of the the Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University. After a detailed description of the study, informed consent was obtained from patients or their relatives in cases where patients had difficulty writing owing to limb paralysis. This study was conducted in accordance with the Declaration of Helsinki.

Consent for Publication

The authors have all read and approve of this work for publication.

Acknowledgments

We would like to thank Editage (www.editage.cn) for English language editing.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by a grant from the Taizhou Municipal Sci-Tech Bureau Program (20ywa50 and 1701KY58).