TY - JOUR
T1 - Infection-related hypoglycemia in institutionalized demented patients
T2 - A comparative study of diabetic and nondiabetic patients
AU - Arinzon, Zeev
AU - Fidelman, Zeev
AU - Berner, Yitshal N.
AU - Adunsky, Abraham
PY - 2007/9
Y1 - 2007/9
N2 - Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics (p = 0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.
AB - Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics (p = 0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.
KW - Diabetes mellitus in elderly
KW - Hypoglycemia
KW - Long-term care
KW - Mortality in infection-related hypoglycemia
UR - http://www.scopus.com/inward/record.url?scp=34447647852&partnerID=8YFLogxK
U2 - 10.1016/j.archger.2006.10.010
DO - 10.1016/j.archger.2006.10.010
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AN - SCOPUS:34447647852
SN - 0167-4943
VL - 45
SP - 191
EP - 200
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
IS - 2
ER -
