Inpatient hypoglycemia is linked to greater amputation risk

Takeaway

• Inpatient hypoglycemia is an independent risk factor for amputations in patients with diabetic foot ulcers (DFUs).
• In-hospital hypoglycemia should be minimized.

Why this matters

• An estimated 50%-70% of lower extremity amputations are preceded by a DFU.
• DFUs are associated with significant financial burden, impaired QoL, and reduced life expectancy.

Study design

• Retrospective cohort study including 418 patients hospitalized for DFUs during 2015-2017.
• Definitions:
  • Hyperglycemia: ≥3 blood glucose measurements of ≥250 mg/dL (13.9 mmol/L).
  • Severe hyperglycemia: ≥3 of ≥350 mg/dL (19.4 mmol/L).
  • Hypoglycemia: ≥1 measurement of <70 mg/dL (3.9 mmol/L).
  • Severe hypoglycemia: ≥1 of <54 mg/dL (3 mmol/L).
• Funding: None.

Key results

• During hospitalization: 
  • 73% experienced any hyperglycemia, including 30% with severe hyperglycemia.
  • 48% experienced any hypoglycemia, including 22% with severe hypoglycemia.
  • 55% underwent amputation, including major amputation in 47%.
• Amputations:
  • 58.70% with inpatient hyperglycemia vs 21.80% without (P<.05);
  • 66.20% with hypoglycemia vs 44.20% without (P<.001).
• Major amputations:
  • 28.50% with inpatient hyperglycemia vs 18.60% without (P<.05).
  • 35.30% with hypoglycemia vs 17.10% without (P<.001).
• Severe hypoglycemia but not severe hyperglycemia was significantly associated with any amputation (P=.0008 vs P=.1924) and major amputation (P<.0001 vs P=.333).   

Limitations

• Retrospective, observational study.
• HbA1c measurements unavailable.