Prevention of inpatient hypoglycemia with a real-time informatics alert

J Hosp Med. 2014 Oct;9(10):621-6. doi: 10.1002/jhm.2221. Epub 2014 Jun 5.


Background: Severe hypoglycemia (SH), defined as a blood glucose (BG) <40 mg/dL, is associated with an increased risk of adverse clinical outcomes in inpatients.

Objective: To determine whether a predictive informatics hypoglycemia risk-alert supported by trained nurse responders would reduce the incidence of SH in our hospital.

Design: A 5-month prospective cohort intervention study.

Setting: Acute care medical floors in a tertiary care academic hospital in St. Louis, Missouri.

Patients: From 655 inpatients on designated medical floors with a BG of <90 mg/dL, 390 were identified as high risk for hypoglycemia by the alert system.

Measurements: The primary outcome was the incidence of SH occurring in high-risk intervention versus high-risk control patients. Secondary outcomes included: number of episodes of SH in all study patients, incidence of BG < 60 mg/dL and severe hyperglycemia with a BG >299 mg/dL, length of stay, transfer to a higher level of care, the frequency that high-risk patient's orders were changed in response to the alert-intervention process, and mortality.

Results: The alert process, when augmented by nurse-physician collaboration, resulted in a significant decrease by 68% in the rate of SH in alerted high-risk patients versus nonalerted high-risk patients (3.1% vs 9.7%, P = 0.012). Rates of hyperglycemia were similar on intervention and control floors at 28% each. There was no difference in mortality, length of stay, or patients requiring transfer to a higher level of care.

Conclusion: A real-time predictive informatics-generated alert, when supported by trained nurse responders, significantly reduced inpatient SH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Algorithms
  • Blood Glucose / analysis
  • Body Weight
  • Creatinine / blood
  • Female
  • Humans
  • Hypoglycemia / prevention & control*
  • Incidence
  • Inservice Training / organization & administration
  • Insulin / metabolism
  • Male
  • Middle Aged
  • Missouri
  • Nursing Staff, Hospital / organization & administration*
  • Personnel, Hospital
  • Prospective Studies
  • Risk Assessment
  • Sensitivity and Specificity


  • Blood Glucose
  • Insulin
  • Creatinine