Hypoglycemia All Too Common In Hospice and End of Life Care

MedicalResearch.com Interview with:
Dr. Laura A. Petrillo MD
Instructor in Medicine
Harvard Medical School, and Palliative Care Physician
Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hospice is end-of-life care focused on maximizing quality of life. Hospice often involves reducing or stopping treatments that are unlikely to have short-term benefit in order to avoid uncomfortable side effects. About a quarter of Americans die in nursing homes, and some of them receive hospice care in their final days. We looked at whether adults with type 2 diabetes experience low blood sugar while on hospice in veterans’ nursing homes, since low blood sugar signals inappropriately aggressive diabetes treatment in patients close to death and contributes to unnecessary discomfort.

We found that one in nine people experienced low blood sugar at least once while receiving hospice care. Among people who were on insulin, the number was one in three.

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Hypoglycemia Linked To Increased Mortality in Hospitalized Patients

MedicalResearch.com Interview with:
Amit Akirov, MD
Institute of Endocrinology
Rabin Medical Center- Beilinson Hospital
Petach Tikva, Israel

MedicalResearch.com: What is the background for this study?

Response: As hypoglycemia is common among hospitalized patients with and without diabetes mellitus, we aimed to investigate the association between spontaneous and insulin-related hypoglycemia including severe hypoglycemia and all-cause mortality among a large cohort of hospitalized patients.

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Quality Performance Measures Should Include Hypoglycemia Assessments

MedicalResearch.com Interview with:

Victor M. Montori, MD Mayo Clinic

Dr. Victor Montori

Victor M. Montori, MD MSc
Knowledge and Evaluation Research Unit in Endocrinology
Mayo Clinic, Rochester, Minnesota

MedicalResearch.com: What is the background for this study?

Response: Hypoglycemia can acutely disrupt patients’ lives through symptoms ranging from bothersome to life-threatening; worsen quality of life; and hinder medication adherence and glycemic control. Hypoglycemia is now known to increase risk of mortality, cognitive impairment, and cardiovascular events. In order to improve the quality of diabetes care, healthcare organizations use publicly reported performance measures for quality measurement and improvement, and pay-for-performance initiatives. The degree to which existing performance measures are aligned with guidelines, particularly in regard to hypoglycemia avoidance, is uncertain.

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Emergency Room Visits for Insulin-Related Hypoglycemia

Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC.MedicalResearch.com Interview with:
Andrew I. Geller, MD
Medical Officer in the Division of Healthcare Quality Promotion at CDC.

MedicalResearch.com: What are the main findings of the study?

Dr. Geller: Using CDC’s national medication safety monitoring system, we estimated that, each year, there were about 100,000 visits made to U.S. emergency departments (EDs) for insulin-related hypoglycemia and errors during 2007-2011, or about half a million ED visits over the 5-year study period.  This is important because many of these ED visits for insulin-related hypoglycemia may be preventable.

We also found these ED visits were more common with increasing age:  every year, 1 in 49 insulin-treated seniors (aged 65 years or older) visited the ED because of hypoglycemia while on insulin or because of a medication error related to insulin. Among the very elderly (aged 80 years or older), this number was 1 in 8 annually.
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