Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study.

The objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61-84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011-2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387-0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072-2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

Sex difference in the association between malnutrition and hypoglycemia in hospitalized patients.

BACKGROUND: The aim of this paper was to examine the difference between males and females regarding association between malnutrition risk and hypoglycemia through a sub-analysis of a cross-sectional study of newly admitted patients to internal medicine departments. METHODS: Malnutrition risk, assessed with Nutritional Risk Screening 2002 (NRS2002), and serum albumin were measured upon admission. Logistic regression was applied to men and women separately, to test the effect of malnutrition and hypoalbuminemia on incidence of hypoglycemia. RESULTS: Included were 1186 patients (50.4% males, 39.2% with positive NRS2002). Rate of positive NRS2002 was similar across sexes (36.5% vs. 41.2% in males and females respectively, P=0.204). Among females, NRS2002 was associated with higher incidence of hypoglycemia (9.5% vs. 2.4% in NRS2002 negative females, P<0.001). Among males, no such difference was noted (9.2% compared to 7.1% in NRS2002 positive and negative males respectively, P=0.520). The weight loss/decreased food intake criterion of the NRS2002 was significantly higher in the hypoglycemic group within females (P=0.03). Logistic regression showed that serum albumin was inversely associated with hypoglycemia in both females (OR 0.477, 95% CI 0.282-0.806, P=0.006) and males (OR 0.532, 95% CI 0.355-0.795, P=0.002). However, increased malnutrition risk was associated with hypoglycemia only among females (OR 2.007, 95% CI 1.058-3.809, P=0.033). Diabetes status was associated with hypoglycemia (OR 1.907, 95% CI 1.056-3.445, P=0.032) only in males; this association did not occur in females. CONCLUSIONS: Malnutrition risk, as measured by the NRS2002, is associated with significantly increased incidence of hypoglycemia in women alone. Females who lose weight prior to hospitalization have an increased risk to develop hypoglycemia.

Malnutrition risk is associated with hypoglycemia among general population admitted to internal medicine units. Results from the MENU study.

BACKGROUND/OBJECTIVES: To examine the association between increased malnutrition risk upon admission, and the incidence of hypoglycemia among adult patients admitted to internal medicine units in Israel. SUBJECTS/METHODS: This was a cross-sectional study, and included were all adult patients admitted to internal medicine units, regardless of reason for admission. The NRS2002 was used to for nutritional screening. All glucose measurements were obtained using an institutional blood glucose-monitoring system, which consisted of a point of care, automated glucometer, and an interactive database. Patients were categorized as hypoglycemic if they had at least one documented hypoglycemia (= <70 mg/dL) event during the hospitalization period. Blood chemistry measured at admission was also recorded. RESULTS: Included were 876 patients (mean age 70.0 ± 17.3, 50.6% were males). Rate of positive malnutrition screen was 39.7% of the population. A total of 5.4% of the study population had at least one hypoglycemic event during hospitalization. Rate of diabetes mellitus did not differ between patients with or without hypoglycemia. A greater proportion of patients with hypoglycemia were at increased malnutrition risk compared to patients without documented hypoglycemic events (56.8% vs. 38.9%, p = 0.018). Patients who had hypoglycemia had higher NRS2002 scores for pre-hospitalization unintentional weight loss and reduced food consumed. In logistic regression analysis, increased malnutrition risk was associated with hypoglycemia occurrence (OR 1.982, 95% confidence interval 1.056-3.718, p = 0.033). Age, sex, and diabetes mellitus status did not affect the rate of hypoglycemia. CONCLUSIONS: Our data suggest increased malnutrition risk as measured by the NRS2002 almost doubled the risk for hypoglycemia during the hospitalization.