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Reduction of serum albumin in non-critically ill patients during hospitalization is associated with incident hypoglycaemia - 27/04/19

Doi : 10.1016/j.diabet.2019.03.003 
I. Khanimov a, , J. Wainstein a, b, M. Boaz c, M. Shimonov a, d, E. Leibovitz e
a Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel 
b Diabetes Unit, E. Wolfson Medical Center, Holon, Israel 
c Department of Nutrition Sciences, Ariel University, Ariel, Israel 
d Department of Surgery ‘A’, E. Wolfson Medical Center, Holon, Israel 
e Department of Internal Medicine ‘A’, Yoseftal Hospital, Eilat, Israel 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 27 avril 2019

Highlights

Decreased albumin is associated with increased hypoglycaemia and mortality.
A direct correlation was found between decreased albumin and mean glucose levels.
The association between hypoglycaemia and mean glucose level is U-shaped.

Le texte complet de cet article est disponible en PDF.

Abstract

Aim

Our study looked at the association between changes in serum albumin (SA) levels during hospitalization and incidence of hypoglycaemia among non-critically ill patients.

Methods

Included were patients discharged from internal medicine units with hospital stays ≤ 14 days. Patients were allocated to three groups: (1) admission SA > 3.5 g/dL with no decrease during hospitalization; (2) admission SA < 3.5 g/dL with no decrease during hospitalization; and (3) decrease in SA regardless of admission SA level. Incident hypoglycaemia (glucose ≤ 70 mg/dL) was predicted by applying regression analysis, using hypoglycaemia as a dependent variable. Mortality studies were performed using Cox regression.

Results

Included were 7718 patients (mean age 71.8 ± 17.4 years, 49.9% males, 27.1% with diabetes). Of these patients, 12.7% had at least one documented hypoglycaemia episode during hospitalization. Patients with decreases in SA levels during hospitalization (group 3) had higher rates of incident hypoglycaemia compared with patients in groups 1 and 2 (21.0% vs. 6.0% and 16.3%, respectively; P < 0.001 for both). Results remained significant after controlling for admission SA. Strong negative correlations were observed between SA and serum osmolarity (r = −0.204, P < 0.0001) and, separately, between changes in SA with changes in serum osmolarity (r = −0.157, P < 0.001), indicating that SA changes were not due to haemodilution. Overall 1-year mortality was 16.7%, and Cox regression analysis showed an increased 1-year mortality in patients in group 3 (27.9%) compared with those in groups 1 and 2 (15.2% and 13.8%, respectively).

Conclusion

Changes in SA during hospitalization are associated with an increased risk of hypoglycaemia during hospitalization of non-critically ill patients.

Le texte complet de cet article est disponible en PDF.

Keywords : Albumin, Diabetes mellitus, Hypoglycaemia, Mortality, Osmolarity


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