TY - JOUR
T1 - Hypoglycemic risk exposures in relation to low serum glucose values in ambulatory patients
AU - Abusamaan, Mohammed S.
AU - Marzinke, Mark A.
AU - Ashok, Aditya
AU - Carroll, Karen
AU - Lane, Kyrstin
AU - Jeun, Rebecca
AU - Moseley, Kendall F.
AU - Carson, Kathryn A.
AU - Mathioudakis, Nestoras N.
N1 - Funding Information:
Nestoras Mathioudakis was supported by grant 1K23DK111986-01 from the National Institute for Diabetes and Digestive and Kidney Diseases. K.A. Carson's work on the project was funded by the Johns Hopkins Institute for Clinical and Translational Research, under grant number UL1 TR001079 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research.
Funding Information:
Nestoras Mathioudakis was supported by grant 1K23DK111986-01 from the National Institute for Diabetes and Digestive and Kidney Diseases. K.A. Carson’s work on the project was funded by the Johns Hopkins Institute for Clinical and Translational Research, under grant number UL1 TR001079 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research.
Publisher Copyright:
© 2020 the Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.
AB - This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.
KW - ambulatory
KW - critical action value
KW - glucose
KW - hypoglycemia
KW - laboratory
KW - risk factors
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UR - http://www.scopus.com/inward/citedby.url?scp=85077738121&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000018679
DO - 10.1097/MD.0000000000018679
M3 - Article
C2 - 31914062
AN - SCOPUS:85077738121
SN - 0025-7974
VL - 99
JO - Medicine (United States)
JF - Medicine (United States)
IS - 2
M1 - e18679
ER -