Background: The risk factors for hypoglycemia during hospital admission and its consequences in patients with diabetes are not entirely known. The present study aimed to investigate the risk factors for hypoglycemia, as well as the potential implications of hypoglycemia in patients with type 2 diabetes mellitus admitted to the hospital. Methods: This retrospective cohort study included 324 patients (214 [66.0%] men; median age 70 years, range 34–95 years) with type 2 diabetes admitted to a university hospital who were consulted the Endocrinology Department for glycemic control during a 12-month period. We investigated the potential role of demographic factors, metabolic factors, therapy, and comorbidities on the development of in-hospital hypoglycemia. We explored the prognostic value of hypoglycemia on mortality (both in-hospital and in the long-term), hospital readmission in the following year, and metabolic control (HbA1c value) after discharge (median follow-up, 886 days; range 19–1255 days). Results: Hypoglycemia occurred in 154 (47.5%) patients during their hospitalization and was associated with advanced age, previous insulin therapy, higher Charlson Comorbidity Index, lower body mass index and lower baseline HbA1c values. Hypoglycemia was associated with greater in-hospital and long-term mortality, longer hospital stays, higher readmission rates, and poorer metabolic control after discharge. These negative consequences of hypoglycemia were more frequent in patients with severe (≤ 55 mg/dL) hypoglycemia and in patients who had hypoglycemia during a greater percentage of hospitalization days. Conclusions: Hypoglycemia during hospital admission is a marker of a poor prognosis in patients with type 2 diabetes.

Background: Few studies have evaluated the implications of the alarm thresholds of continuous glucose monitoring (CGM) systems for individuals with diabetes. The present study aimed to investigate the influence of hypoglycemia and hyperglycemia alarm thresholds on glycemic control in adults with type 1 diabetes (T1DM) and the characteristics of patients who use these alarms more frequently. Methods: This observational cross-sectional study included 873 users of the FreeStyle Libre 2 system (501 men, median age 48 years, range 18–90 years) with T1DM from a single center. We investigated the role of demographic and metabolic factors on the use of alarms and the impact of hypoglycemia and hyperglycemia alarms and their thresholds on glycemic control. Results: Alarm users were older than nonusers (median age 49 vs. 43 years, respectively; P < 0.001). The hypoglycemia alarms were set by 76.1% of women and by 69.1% of men ( P = 0.022). The hypoglycemia alarms reduced hypoglycemia features and glucose variability, although at the expense of shorter time in range. The higher the hypoglycemia alarm threshold, the greater these effects. The hyperglycemia alarms were effective in reducing hyperglycemia and lowering the glucose management indicator, although at the expense of a greater tendency to hypoglycemia. The lower the hyperglycemia alarm threshold, the greater these effects. Conclusions: CGM alarms contribute to better glycemic control. However, hypoglycemia and hyperglycemia alarms have advantages and disadvantages. Adults with T1DM should explore, under medical supervision, which alarm thresholds will best help them achieve their individual glycemic goals.

Background: Previous research has indicated that hypoglycemia during hospitalization is a predictor of unfavorable outcomes in patients with diabetes. However, no studies have examined the long-term impact of hypoglycemia in adults admitted for hyperglycemic crises. The study was aimed to investigate the long-term implications of hypoglycemia during hyperosmolar hyperglycemic crises, particularly in terms of all-cause mortality. Methods: This retrospective cohort study included 170 patients (82 men [48.2%], median age 72 years) admitted to a university hospital for hyperosmolar hyperglycemic crises, including pure hyperosmolar hyperglycemic states and hyperosmolar diabetic ketoacidoses. We separately investigated the prognostic significance of hypoglycemia on mortality during the initial intravenous insulin therapy phase and during the later subcutaneous insulin therapy phase, both during hospitalization and in the long term (median follow-up, 652 days; range 2–3460 days). Results: Both hypoglycemia during the initial intravenous insulin therapy phase (observed in 26.5% of patients) and hypoglycemia during the later subcutaneous insulin therapy phase (observed in 52.7% of patients) were associated with long-term mortality. After adjusting for potential confounders, hypoglycemia during the initial intravenous insulin therapy phase remained associated with mortality (hazard ratio 2.10, 95% CI 1.27–3.46, p = 0.004). Conclusions: Hypoglycemia during hyperosmolar hyperglycemic crises is a marker of long-term mortality, especially when it occurs during the initial intravenous insulin therapy phase.

Background: There are no studies on the clinical significance of asymptomatic hypoglycemia detected incidentally during routine testing. Methods: Baseline fasting serum glucose was determined in 1333 individuals without diabetes (43.3% males, median age 50 years, range 18 to 91 years) to investigate the prevalence of hypoglycemia (fasting serum glucose <70 mg/dL) and the associated demographic, lifestyle, and metabolic factors. Individuals with baseline hypoglycemia were followed (median follow-up, 8.7 years) and assessed for hypoglycemia symptoms. Seven-day continuous glucose monitoring was performed in a subsample of 489 individuals. Results: Baseline hypoglycemia was observed in 20 individuals (weighted prevalence, 1.58%, 95% confidence interval 0.87%–2.28%). Hypoglycemia was mild and asymptomatic in all cases (median, 67 mg/dL, range 63 to 69 mg/dL). The characteristics of those with hypoglycemia were similar to those with fasting serum glucose 70 to 80 mg/dL. Hypoglycemia was associated with female sex, younger age, and a more favorable metabolic profile (lower body mass index, glycohemoglobin and insulin resistance) than individuals with fasting serum glucose >80 mg/dL. Individuals with baseline hypoglycemia showed no distinct hypoglycemia features in continuous glucose monitoring (n = 9). During follow-up (n = 19), hypoglycemia in routine determinations, always mild, recurred in 42.1% of individuals, although the mean of successive glucose concentrations was higher than baseline in all cases. None of the individuals had symptoms that could constitute Whipple9s triad (low serum glucose, symptoms of hypoglycemia, and symptomatic improvement after correction of hypoglycemia) during the follow-up period. Conclusions: Detection of asymptomatic, mild hypoglycemia in routine blood tests is not indicative of disease and does not require further investigation.

Background and aim: Few real-life studies have analyzed the glycemic response to nutrients in individuals without diabetes. We investigated the glycemic response to evening meals in relation to individual characteristics, nutrient components, and preprandial and postprandial routines. Methods: A cross-sectional study of 489 individuals without diabetes from a randomly selected general adult population (310 women, median age 46 years, range 18-84 years) was conducted using a continuous glucose monitoring device for 7 days. The study recorded the participants' glycemic profile at 6 h after dinner, the food consumed at dinner, the fasting duration before dinner, and the duration between the end of dinner and going to bed. Principal component analysis and multilevel functional data analysis were used to interpret the data. Results: On average, a postprandial glycemic peak was observed at 45 min, followed by a decline to baseline levels from 90 min onwards. Older age, higher body mass index, and large meals (especially those high in starch and dairy products) were all significantly associated with higher glucose levels throughout the 6 h after dinner. The fruit component was associated with a higher initial glycemic peak, followed by a lowering glycemic effect thereafter (p < 0.001). The alcohol component was associated with an initial hypoglycemic effect (p = 0.006). The participants who fasted longer before dinner had higher postprandial glycemic peaks (p = 0.001), and those who went to bed later had higher postprandial glucose levels than those who went to bed earlier (p = 0.003). Conclusions: The participants' characteristics, nutrient components, and pre- and post-dinner routines have divergent effects on post-dinner glycemic response. (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).