Iatrogenic Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention Analysis of Current Practice at an Academic Medical Center With Implications for Improvement Efforts

We performed a 130-patient case-control study to examine the patient and hospital care risk factors for experiencing a hypoglycemic patient-day, comparing these factors to similar control patients who were not experiencing a hypoglycemic patient-day. We also examined adherence to our hypoglycemia management protocols, documentation of the event, and adjustments to medications and nutritional regimens that occurred in response to the hypoglycemic event. The most powerful risk factors for hypoglycemia were unexpected nutritional interruption, prior hypoglycemia during the hospital stay, and asynchrony of nutrition delivery and insulin administration. Adherence to hypoglycemia management and documentation standards was poor. Here, we outline strategies to focus improvement efforts on adherence to hypoglycemia treatment protocols and proactive management of patients with these key hypoglycemia risk factors.