12273 Do The First 48 Hours Of Hospitalization Require More Vigilance In Geriatric Patients At Risk Of Hypoglycemia?
Authors: Ravi Samyukta , Fredrick Jason , Munasinghe Uthpala , Aravind Subhiksha , Ejaz Amna , Feisal Sylesh , Syeda Hafsa , Mahvish Gull , Anjum Reema , Afsana Hrede 
Published: October 2024

Disclosure: S. Ravi: None. H. Afsana: None.

Hypoglycemia (HG; blood glucose &lt;70 mg/dL) is a commonly encountered problem in hospitalized patients and is associated with significant morbidity and mortality as well as increased healthcare costs. Elderly patients are particularly vulnerable to HG as they are more likely to have autonomic dysfunction, resulting in fewer discernible symptoms as well as an impaired counterregulatory response, making it more likely that events go undetected and uncompensated. A survey of the literature identifies a number of risk factors for developing HG, including nephropathy, liver disease, infection, cognitive dysfunction, as well as sulfonylurea and long-term insulin use. Given the significant risks posed by HG, we pose the question: how can we do better to identify geriatric patients at high risk of HG events? In this retrospective chart review, data was collected from charts of patients aged 65-99 years with HG, who presented to the ED and were hospitalized for various reasons at a community hospital. Patients were included if a diagnosis of HG was documented in the EMR during hospitalization regardless of diagnosis of Diabetes Mellitus (DM). In 219 total individuals, potential associated variables were analyzed using descriptive statistics, chi-square tests, and Fisher’s exact tests. When data was not complete for any individual variables, the incomplete data was excluded during respective analysis. Among 219 patients, 128 (58.45%) presented at the time of admission, 33 (15.07%) presented within 24 hours after, 15 (6.85%) presented between 24 - 47 hours after, and 43 (19.63%) presented ≥48 hours after admission. Overall, 80.37% of HG events occurred within the first 48 hours of hospitalization. Interestingly there was no significant relationship identified between severity of HG events and HbA1c. The percent distribution identified delayed or missed meals (33%), insulin use (26%), and infection (8%), as the most common potential causes. These findings suggest that it is beneficial to extend the suspicion of HG events to all geriatric patients, regardless of diagnosis of DM. While validated tools have been proposed to identify diabetic patients at risk for HG, fewer studies have been done to identify potential markers of HG risk in all geriatric patients. It may be that the first 48 hours pose a critical period to identifying and better managing these patients’ blood sugars. While use of continuous glucose monitoring in the inpatient setting has been proposed as a potential solution, other cost-effective methods include ensuring timely delivery of meals and food intake, as well as closer finger stick glucose monitoring in the first 48 hours. Higher powered studies across a wider variety of clinical settings are required to further investigate hypoglycemic events in geriatric patients and to synthesize validated assessment tools.

Presentation: 6/2/2024