Chan Wharton O Y, Lim Paik Shia, Ang Alcey Li Chang, Goh Su-Yen, Bee Yong Mong, Teh Ming Ming
Programme in Emerging Infectious Disease, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
Ther Adv Endocrinol Metab. 2025 May 8;16:20420188251338749. doi: 10.1177/20420188251338749. eCollection 2025.
Inpatient hypoglycaemia has been well studied around the world, and more tools are being developed to understand and predict hypoglycaemic episodes. Most published data, however, focuses on patient characteristics and predictions of whether a patient would have a hypoglycaemic episode during inpatient stay. There is a paucity of data concerning the timing, as well as types of diabetic medications used, surrounding a hypoglycaemia episode.
To characterise inpatient hypoglycaemia episodes by time and associated diabetes medications, on top of baseline patient characteristics.
Retrospective observational study of 425 hypoglycaemia episodes, over a 2 month period from two general internal medicine wards, in a tertiary medical hospital.
A discrete hypoglycaemic episode is defined as a capillary blood glucose (CBG) reading of <4 mmol/L. Hypoglycaemic episodes were further sub-analysed by dividing them into three time frames - day (0801-1600), evening (1601-2359) and night (0000-0800).
In total, 425 hypoglycaemia episodes from 207 patients were analysed. Sulphonylurea (SU), premixed, basal and basal-bolus insulin regimens were associated with 31.8%, 30.4%, 15.1% and 5.9% of the hypoglycaemia episodes, respectively. All agents revealed significant intra-day differences ( < 0.05) except for the basal-bolus insulin regimen ( = 0.76). Basal insulin and sulphonylurea-associated hypoglycaemia occurred mostly in the midnight timeframe (0000-0800) at 65.6% and 47.4%, respectively, whereas premixed insulin-associated hypoglycaemia occurred mostly in the evening timeframe (1601-2359) at 51.2%. In total, there were significant differences in the distribution of hypoglycaemia across the three time frames associated with different diabetes medications ( < 0.05).
There are marked differences in the medications associated with inpatient hypoglycaemia at differing time points. These time points offer insight into appropriate CBG testing timings for different diabetes medications. Hence, stratified monitoring and strategic 3 a.m. testing of CBG for patients on sulphonylurea and basal insulin should be considered in tackling inpatient hypoglycaemia.
全球范围内对住院患者低血糖进行了充分研究，并且正在开发更多工具来了解和预测低血糖发作。然而，大多数已发表的数据集中在患者特征以及患者在住院期间是否会发生低血糖发作的预测上。关于低血糖发作的时间以及所用糖尿病药物类型的数据很少。
除了基线患者特征外，按时间和相关糖尿病药物对住院患者低血糖发作进行特征描述。
对一家三级医院两个普通内科病房在2个月期间内的425次低血糖发作进行回顾性观察研究。
一次离散的低血糖发作定义为毛细血管血糖（CBG）读数<4 mmol/L。低血糖发作进一步细分为三个时间段——白天（08:01 - 16:00）、晚上（16:01 - 23:59）和夜间（00:00 - 08:00）进行亚分析。
共分析了207例患者的425次低血糖发作。磺脲类（SU）、预混胰岛素、基础胰岛素和基础 - 餐时胰岛素方案分别与31.8%、30.4%、15.1%和5.9%的低血糖发作相关。除基础 - 餐时胰岛素方案（P = 0.76）外，所有药物均显示出显著的日内差异（P < 0.05）。基础胰岛素和磺脲类相关低血糖分别大多发生在午夜时间段（00:00 - 08:00），占65.6%和47.4%，而预混胰岛素相关低血糖大多发生在晚上时间段（16:01 - 23:59），占51.2%。总体而言，不同糖尿病药物相关的低血糖在三个时间段的分布存在显著差异（P < 0.05）。
不同时间点与住院患者低血糖相关的药物存在显著差异。这些时间点为不同糖尿病药物的适当CBG检测时间提供了见解。因此，在处理住院患者低血糖时，应考虑对使用磺脲类和基础胰岛素的患者进行分层监测和凌晨3点的CBG策略性检测。
