#Aging and comorbidities influence the risk of hospitalization and mortality in #diabetic patients experiencing severe hypoglycemia

Severe hypoglycemia requiring access to the Emergency Department is more frequent in older patients with multiple comorbidities.

Risk of hospitalization and mortality within one year since the hypoglycemic event is higher in older frail patients.

Severe hypoglycemia could increase the cardiovascular risk and could be a marker of future cardiovascular events.

A less stringent glycemic control and the adoption of therapeutic strategies aiming to prevent hypoglycemia is warranted in elderly patients with declining health status.


Abstract
Background and Aims
To assess the risk of hospitalization and mortality within 1 year of severe hypoglycaemia and theirs clinical predictors.


Methods and Results
We retrospectively examined 399 admissions for severe hypoglycemia in adults with DM at the Emergency Department (ED) of the University Hospital of Novara (Italy) betweeen 2012-2017, and we compared the clinical differences between older (aged ≥ 65 years) and younger individuals (aged 18-64 years). A logistic regression model was used to explore predictors of hospitalization following ED access and 1-year later, according to cardiovascular (CV) or not (no-CV) reasons; 1-year all-cause mortality was also detected.
The study cohort comprised 302 patients (median [IQR] age 75 [17] years, 50.3% females, 93.4% white, HbA1c level 7.6% [1.0%]). Hospitalization following ED access occurred in 16.2% of patients and kidney failure (OR .50 [95% CI 1.29-5.03]) was the only predictor of no-CV specific hospitalization; 1-year hospitalization occurred in 24.5% of patients and obesity (OR 3.17 [95% CI 1.20-8.12]) and pre-existing heart disease (OR 3.20 [95% 1.20-9.39]) were associated with CV specific hospitalization; 1-year all-cause mortality occurred in 14.9% of patients and was associated with older age (OR 1.12 [95% CI 1.07-1.18]) and pre-existing heart disease (OR 2.63 [95% CI 1.19-6.14])


Conclusions
Severe hypoglycemia is associated with risk of hospitalization and mortality mainly in elderly patients and it may be predictive of future cardiovascular events in diabetic patients with pre-existing heart disease and obesity.

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