JMIR Publications

ABSTRACT

Background:

Inpatient hypoglycemia remains a common and potentially preventable adverse event among hospitalized patients with diabetes mellitus (DM). Severe hypoglycemia is associated with increased morbidity, mortality, prolonged hospitalization, and healthcare costs. Continuous surveillance programs led by DM nurse practitioners may improve early detection and management of hypoglycemic events

Objective:

To evaluate the impact of a DM nurse practitioner-led surveillance program on the severity and clinical characteristics of inpatient hypoglycemia.

Methods:

This retrospective cohort study was conducted at a tertiary medical center and included hospitalized adults with DM who experienced hypoglycemia during three study periods: pre-intervention (September-December 2022) and two post-intervention periods (September-December 2023 and September-December 2024). Beginning in January 2023, DM nurse practitioners conducted daily computerized surveillance of hypoglycemic events, followed by individualized case reviews, treatment recommendations, staff education, patient counseling, and follow-up. Hypoglycemia was defined as blood glucose <70 mg/dL and severe hypoglycemia as <54 mg/dL. Multivariable logistic regression was performed to identify independent predictors of severe hypoglycemia.

Results:

A total of 721 hospitalizations of patients with DM and hypoglycemic event were analyzed (147 in 2022, 290 in 2023, and 284 in 2024). Following implementation of the surveillance program, the observed rate of hypoglycemic events increased from 7.4 to 14.5 events per 100 hospitalized patients with DM. Despite this increase, hypoglycemia severity decreased substantially over time. The proportion of severe hypoglycemia (<54 mg/dL) declined from 31.3% in 2022 to 25.2% in 2023 and 11.6% in 2024 (P<0.001). Similar reductions were observed across progressively lower glucose thresholds, with profound hypoglycemia (<40 mg/dL) decreasing from 17.7% to 4.6% (P<0.001). Significant reductions in severe hypoglycemia were observed during both morning shifts (29.3% to 9.5%, P<0.001) and evening shifts (35.6% to 14.8%, P<0.001), as well as during weekdays and weekends. In multivariable analysis, the 2024 study period remained independently associated with a lower likelihood of severe hypoglycemia compared with 2022 (adjusted OR 0.28, 95% CI 0.17–0.47; P<0.001), corresponding to a 72% relative reduction in the odds of severe hypoglycemia. Evening-shift events were independently associated with increased risk of severe hypoglycemia (adjusted OR 2.15, 95% CI 1.39–3.31; P<0.001).

Conclusions:

Implementation of a DM nurse practitioner–led surveillance program was associated with a marked and sustained reduction in the severity of inpatient hypoglycemia despite increased detection of hypoglycemic events. These findings suggest that proactive nurse-led surveillance may improve inpatient glycemic safety and facilitate earlier identification and intervention before progression to severe hypoglycemia.