SUN-575 - When the Hospitalized Patient Cannot Communicate: Effects on Hypoglycemia Event Resolution and Recurrence

Hypoglycemia is a life-threatening complication of insulin therapy. There has been limited exploration of how an individual’s ability to communicate with the healthcare team may impact the duration and resolution of hypoglycemia events in the hospital. The goal of this study was to evaluate the effects of impaired communication on event resolution and recurrence of hypoglycemia after an index Level 2 hypoglycemia (blood glucose (BG) ≤ 54 mg/dL) event among hospitalized adults.

All Level 2 hypoglycemia events at a tertiary care teaching hospital included in quarterly medication safety reports between December 2022 to September 2024 were retrospectively reviewed. Data was obtained from the safety reports and review of the electronic medical record. Impaired communication was defined as the inability to communicate verbally with the healthcare team and identified in the record with the following terms or conditions: altered mental status, aphasia, dementia, respiratory intubation with sedation, and documented preferred non-English language. Covariates of interest included demographics, diabetes status, hemoglobin A1C, renal function, body mass index, and total insulin dose by weight in the 24 hours preceding the event. Outcomes of interest include duration of hypoglycemia and recurrence rate. Recurrence was defined as the occurrence of a hypoglycemic event > 2 hours from resolution (BG > 70 mg/dL) of the index event.

There were 210 Level 2 hypoglycemia events across 127 patients (47 with impaired communication). 69 events occurred in patients with impaired communication and 141 in those without. Of the patients with communication barriers, 20.3% had a non-English language preference, 33.3% were with altered mental status, and 31.9% were intubated and sedated. Preliminary analysis revealed an increased rate of hypoglycemic recurrence in patients with communication barriers when compared to those without (18.8% vs 12.1%). Median time to hypoglycemia resolution was 62 minutes (IQR 37–113) in the communication-barrier group versus 52 minutes (IQR 34–80) in the non-barrier group. Our findings bring attention to the increased risk of insulin-induced hypoglycemia among individuals with impaired communication with their healthcare teams in the hospital setting and encourage a search for strategies to effectively address the increased risk.

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