Factors Associated With Nocturnal Hypoglycemia In A Small Community Hospital Nhien Nguyen, Maggie Braxton Green, Geren ThomasArchbold Memorial Hospital - Thomasville, GA
Background/Purpose: The American Diabetes Association guideline categorizes hypoglycemia in three levels. Level one hypoglycemia is a glucose concentration of 54–69 mg/dL. Level two hypoglycemia is a glucose concentration of <54 mg/dL. Level three hypoglycemia is a severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery, irrespective of glucose level. Nocturnal hypoglycemia is defined as glucose falling below 70 mg/dL and lasting at least 15 minutes anytime from midnight to 6-am. It is important to avoid hypoglycemia in hospitalized patients as there are complications associated with increased cost, length of stay, morbidity, and mortality. The purpose of this study is to analyze and identify risk factors associated with nocturnal hypoglycemia occurring in hospitalized patients in a rural single site hospital.
Methodology: This was a single site, retrospective, cross-sectional study of adult hospitalized patients at a 264-bed community hospital. Data was extracted from electronic the health record and included patient’s gender, race, weight, past medical history, length of stay, renal function, A1C, glucose levels, time of episode, diet orders, medication orders, and signs and symptoms which may have occurred during nocturnal episode. Patient’s blood glucose levels were collected on admission, 24 hours prior to nocturnal hypoglycemic episode and during hypoglycemic episode. Patient’s chart was reviewed 24 hours prior from the time of the episode to identify potential causes. Primary endpoint is identifying factors potentially associated with nocturnal hypoglycemia episodes in hospitalized patients.
Results: From January to December 2025, a total of 451 patients were identified to have a hypoglycemic episode. Exclusion criteria included patient on insulin drip during hospital stay, history of DKA and/or HHS, sleep apnea, history of cirrhosis, hepatitis B and C, adrenal insufficiency, pancreatic diseases. The most common exclusion criteria met were factors related to past medical history, insulin drip or hypoglycemic episodes did not take place during 0000-0600. These patients were then reviewed for potential risk factors that were associated with the hypoglycemic episode. Among review, the blood glucose level ranged from 10 to 69 mg/dL with average of 59 mg/dL. Level one hypoglycemia occurred 691 times while level two occurred 210 times. Of the patients who experienced nocturnal hypoglycemia, 47% had diet order for “nothing by mouth,” 33% of patients were on at least one or more beta-blocker agents, 9% were on a quinolone agent, and 34% were on at least one or more nonsteroidal anti-inflammatory drugs during their hospitalization.
Conclusions: Nocturnal hypoglycemia can be a dangerous medical complication that can be influenced by types of diet, the use of beta-blockers, quinolones, and nonsteroidal anti-inflammatory drugs. Due to the multiple confounders associated with increased risk, a larger population with closer real time monitoring may be needed to directly correlate associated risk factors.
Presentation Objective: Identify potential risk factors associated with nocturnal hypoglycemia occurring in hospitalized patients in a single site community hospital. Self-Assessment: Which of the following is the definition of nocturnal hypoglycemic per the ADA guideline? A.Glucose level < 69 mg/dL and lasting at least 5 minutes from midnight to 0600 B.Glucose level ≤ 70 mg/dL and lasting at least 15 minutes from midnight to 0300 C.Glucose level < 70 mg/dL and lasting at least 15 minutes from midnight to 0600 D.Glucose level < 54 mg/dL and lasting at least 10 minutes from 0300 to 0600
