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- Title
Predicting inpatient hypoglycaemia in hospitalized patients with diabetes: a retrospective analysis of 9584 admissions with diabetes.
- Authors
Stuart, K.; Adderley, N. J.; Marshall, T.; Rayman, G.; Sitch, A.; Manley, S.; Ghosh, S.; Toulis, K. A.; Nirantharakumar, K.
- Abstract
Aims To explore whether a quantitative approach to identifying hospitalized patients with diabetes at risk of hypoglycaemia would be feasible through incorporation of routine biochemical, haematological and prescription data. Methods A retrospective cross-sectional analysis of all diabetic admissions ( n=9584) from 1 January 2014 to 31 December 2014 was performed. Hypoglycaemia was defined as a blood glucose level of <4 mmol/l. The prediction model was constructed using multivariable logistic regression, populated by clinically important variables and routine laboratory data. Results Using a prespecified variable selection strategy, it was shown that the occurrence of inpatient hypoglycaemia could be predicted by a combined model taking into account background medication (type of insulin, use of sulfonylureas), ethnicity (black and Asian), age (≥75 years), type of admission (emergency) and laboratory measurements (estimated GFR, C-reactive protein, sodium and albumin). Receiver-operating curve analysis showed that the area under the curve was 0.733 (95% CI 0.719 to 0.747). The threshold chosen to maximize both sensitivity and specificity was 0.15. The area under the curve obtained from internal validation did not differ from the primary model [0.731 (95% CI 0.717 to 0.746)]. Conclusions The inclusion of routine biochemical data, available at the time of admission, can add prognostic value to demographic and medication history. The predictive performance of the constructed model indicates potential clinical utility for the identification of patients at risk of hypoglycaemia during their inpatient stay.
- Subjects
BLOOD sugar analysis; TREATMENT of diabetes; HYPOGLYCEMIA; ASIANS; BIOLOGICAL models; BLACK people; C-reactive protein; CONFIDENCE intervals; PEOPLE with diabetes; ETHNIC groups; GLOMERULAR filtration rate; HOSPITAL patients; HOSPITAL admission &; discharge; INSULIN; MEDICAL care; MULTIVARIATE analysis; PATHOLOGICAL laboratories; PATIENTS; RESEARCH funding; LOGISTIC regression analysis; ALBUMINS; ACQUISITION of data; SULFONYLUREAS; CROSS-sectional method; RETROSPECTIVE studies; RECEIVER operating characteristic curves; DATA analysis software; DIAGNOSIS; DISEASE risk factors
- Publication
Diabetic Medicine, 2017, Vol 34, Issue 10, p1385
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.13409