Preventing Hypoglycemia in ESRD Patients with Diabetes Mellitus: The Great Challenge
- Diabetic Kidney Disease: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
- Al-adroos, Hira H., Riverside Community Hospital, Riverside, California, United States
Patients with end stage renal disease who have coexisting diabetes mellitus are at an increased risk of developing hypoglycemia. With renal failure, patients have decreased renal gluconeogenesis, glucose reabsorption, and insulin clearance. ESRD patients accounted for about one third of all severe hypoglycemia episodes in hospitalized diabetics. Inadequate dose-adjustment of insulin could be a significant factor contributing to higher rates of hypoglycemia in these patients. In this study, we propose to add a text-based warning for physicians when ordering insulin in order to prevent overcorrection of glucose levels in these patients. Our long term goal is to create an individualized insulin sliding scale for patients with ESRD in order to prevent hypoglycemia and its sequelae.
We conducted an analysis on 1,178 hospitalized patients to evaluate the incidences of hypoglycemia in patients with co-existing diabetes mellitus and end stage renal disease. Our study aimed at understanding whether administering a lower average dose of insulin would decrease the overall number of episodes of hypoglycemia in these patients. The intervention was a text-based electronic reminder for physicians when they ordered insulin. The 2 groups studied were the pre-intervention group from October 2021 to June 2022 and post-intervention group from July 2022 to March 2023. There were 703 patients studied in the pre-intervention period and 474 patients in the post-intervention period.
Upon analysis of the results, it was noted that there was no statistically significant difference between pre and post intervention groups in the number of hypoglycemic episodes. Although not statistically significant, we do see a reduced amount of total hypoglycemic episodes in patients post-intervention who had at least one prior hypoglycemic episode recorded. It should be noted that the cut off for hypoglycemia classification was changed during the course of this study which could have contributed to the lack of statistically significant results.
This study raises attention towards an important complication of end stage renal disease. Recurrent hypoglycemia can further complicate the course of acute illnesses. With the number of hypoglycemic episodes noted to be higher in the pre-intervention group, it is worthwhile to adjust insulin administration for these patients inpatient.