Inpatient hypoglycemia is linked to greater amputation risk

  • Peled S & al.
  • J Clin Endocrinol Metab
  • 27 Jun 2019

  • International Clinical Digest
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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
    • Severe hypoglycemia: ≥1 of
  • 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.