Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Incidence of hypoglycaemia in hospitalised elderly (#277)

Benjamin Kwan 1 2 , Katrin Kosbab-Jackson 1 3 , Veronica Wong 1 , Ramy Bishay 4 , Roger Chen 1 2 , Tim Lambert 2 5 , Le Couteur David 2 6 , Avinash Suryawanshi 1 2
  1. Department of Endocrinology, Concord Repatriation General Hospital, Concord, NSW, Australia
  2. University of Sydney, Sydney, NSW, Australia
  3. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. Department of Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  5. Collaborative Centre for Cardiometabolic Health in Psychosis, Concord Repatriation General Hospital, Concord, NSW, Australia
  6. The ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia

Context and Aims: Hypoglycaemia contributes to excess morbidity and mortality, but is largely preventable.1 Its incidence and effects in the geriatric population are often underappreciated. The Hypoglycaemia in Elderly: Assessing Risk (HEAR) study aims to evaluate risk factors and clinical outcomes of hypoglycaemia in elderly patients admitted to a tertiary teaching hospital in Sydney.

Methods: Medical records were reviewed for patients admitted to a tertiary level teaching hospital with hypoglycaemia as principal or additional diagnosis during the period from July 2010 to June 2015. Hypoglycaemia was defined as a blood glucose value < 4.0 mmol/L. We conducted a preliminary audit of incidence of hypoglycaemia in elderly inpatients (age > 65 years).

Findings: Over the defined period 60,469 patients were admitted under different medical sub-specialties, of which 18,056 (29.9%) had diabetes; the vast majority being type II diabetes. Most patients with diabetes were elderly 12,428 (68.8%). Hypoglycaemia was a frequent occurrence amongst hospitalised patients with diabetes (5.1%; 912 episodes). 713 of these episodes occurred in the elderly. Hypoglycaemia was the principal reason for admission in 78 patients (57 patients were elderly), while hypoglycaemia occurred in 834 patients admitted for other reasons (656 patients were elderly).

Discussion: Elderly hospitalised patients may be more susceptible to hypoglycaemia for various reasons including weight loss, under nutrition, comorbid conditions, impaired hypoglycaemic awareness, tight glycaemic control, and cognitive impairment.2,3 Hypoglycaemia contributes to increasing frailty, disability and poor outcomes.1 Our findings indicate a high incidence of hypoglycaemia in patients admitted to a tertiary teaching hospital, of which the majority were elderly patients. The HEAR study will further evaluate risk factors for hypoglycaemia to improve patient care and clinical outcomes.

Conclusion: Hypoglycaemia is a common but under recognised complication in hospitalised patients with diabetes, and more likely to occur in the elderly.

  1. Abdelhafiz AH, McNicholas E, Sinclair AJ (2016). Hypoglycemia, frailty and dementia in older people with diabetes: Reciprocal relations and clinical implications. Journal of Diabetes and its Complications, 30(8), pp. 1548-1554.
  2. Thorpe CT, Gellad WF, Good CB, Zhang S, Zhao X, Mor M, Fine MJ (2015). Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia. Diabetes Care, 38(4), pp. 588-95.
  3. Bordier L, Buysschaert M, Bauduceau B, Doucet J, Verny C, Lassmann Vague V, Le Floch JP (2015). Predicting factors of hypoglycaemia in elderly type 2 diabetes patients: Contributions of the GERODIAB study. Diabetes & Metabolism, 41(4), pp.301-3.