Impact of glycemic variability and hypoglycemia on adverse hospital outcomes in non-critically ill patients

Diabetes Res Clin Pract. 2014 Mar;103(3):437-43. doi: 10.1016/j.diabres.2013.11.026. Epub 2014 Jan 3.


Aims: To determine if glycemic variability is associated with hospitalization outcomes in non-critically ill patients, and if this association remains after controlling for hypoglycemia.

Methods: A retrospective review was performed on 1276 medical admissions (801 patients) in which insulin was given, ≥6 point of care glucose (POCG) measurements and length of stay (LOS) 2-30 days. Coefficient of variation (%CV) was used to measure glycemic variability. Outcomes included LOS and a composite outcome based on ICU transfer, hospital acquired infections, and acute renal failure (ARF).

Results: There were a median of 18.5 POCG measurements per admission with a mean %CV 34.2 ± 11.1. Hypoglycemia (POCG ≤70 mg/dl [3.9 mmol/l]) occurred in 35.0% of admissions. ICU transfer occurred in 3.3%, hospital acquired infections 4.8%, ARF 8.3%, and composite outcome 13.5%. Adjusting for age, sex, race and Charlson score, every 10 unit increase in %CV was associated with an increase in LOS of 0.27 days (p=0.004), while there was no association between %CV and the composite outcome. For LOS, there was a significant interaction between %CV and hypoglycemia (p=0.07). While there was a non-significant correlation in patients without hypoglycemia, LOS correlated negatively with %CV in patients with hypoglycemia. When considered simultaneously with %CV, hypoglycemia was associated with increased odds of the composite outcome [OR 2.03 (95% CI 1.36-3.01), p=<0.001] and an increase of 2 days in LOS for those with average %CV.

Conclusions: Hypoglycemia, compared to glycemic variability, is more strongly associated with adverse outcomes in hospitalized, non-critically ill patients.

Keywords: Glycemic variability; Hospitalization outcomes; Hypoglycemia; Length of stay; Non-critically ill.

MeSH terms

  • Acute Kidney Injury / etiology
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism*
  • Critical Illness
  • Cross Infection / etiology
  • Diabetes Mellitus / drug therapy*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / complications*
  • Hypoglycemic Agents / adverse effects*
  • Insulin / adverse effects*
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Retrospective Studies


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin