Title: Decreasing hypoglycemic events after administration of anti-diabetic agents Presenter: Lillian James Authors: Lillian James, Amanda Guffey, Jean Goette, Erik Turgeon at Lexington Medical Center Background: Inpatient hypoglycemia remains a significant and preventable complication in hospitalized patients, particularly those receiving insulin or other anti-diabetic medications. Numerous studies have shown that inpatient hypoglycemia is associated with increased morbidity, mortality, length of hospital stay, and healthcare costs. Importantly, many episodes of inpatient hypoglycemia are preventable. The ADA Standards of Care in Diabetes 2025 guidelines emphasize that preventing hypoglycemia is just as important as avoiding hyperglycemia and call for hospital wide protocols to guide insulin dosing and glucose monitoring. The purpose of this study was to implement targeted strategies aimed at reducing the incidence of severe hypoglycemic events, defined as a blood glucose level less than or equal to 40 mg/dL, in hospitalized patients. Methodology: This study was a pre- and post-intervention chart review of severe inpatient hypoglycemic events conducted at a single-center, 607-bed community teaching hospital. The interventions involved implementation of modified insulin orders, which included adjustments to the frequencies and thresholds for sliding scale insulin, instructions to contact the provider regarding basal insulin administration when the patient is NPO, and the introduction of a sliding scale insulin calculator. The purpose of this review was to evaluate the impact of these interventions on the incidence of severe hypoglycemic events in hospitalized patients. A severe hypoglycemic event is defined as a blood glucose level less than or equal to 40 mg/dL occurring within 24 hours of receiving an anti-diabetic medication. The pre-intervention group consisted of patients who experienced a severe hypoglycemic event between January 1, 2025, and June 30, 2025. The post-intervention group included patients who experienced a severe hypoglycemic event between October 15, 2025, and March 31, 2026. Outcomes were manually analyzed by the investigator through EHR- generated data and manual chart review. Results: A total of 4,294 patients were included in the pre-intervention group, and 4,188 patients were included in the post-intervention group. Severe hypoglycemic events occurred in 83 patients in the pre-intervention group and 69 patients in the post-intervention group. The incidence of severe hypoglycemia decreased from 1.9% to 1.6%; however, this reduction was not statistically significant (p = 0.33). Conclusions: Implementation of an insulin calculator and revised insulin order sets resulted in a numerical, but not statistically significant reduction in severe hypoglycemic events. Continued data collection will be essential to better assess the impact of these interventions and determine alignment with national performance standards.
