--- title: "Hypoglycemia and mortality in acute MI | Sutter Health" description: "Hypoglycemia was associated with increased mortality in patients with AMI in pts who developed hypoglycemia spontaneously, not iatrogenically after insulin tx." url: "https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Hypoglycemia and mortality in acute MI # Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. Kosiborod M, Inzucchi SE, Goyal A, Krumholz HM, Masoudi FA, Xiao L, & Spertus JA. _JAMA. 301(15):1556-64. doi: 10.1001/jama.2009.496._ 2009-04-15 ## Abstract CONTEXT: While glucose control is recommended by professional societies for patients with hyperglycemia hospitalized with acute myocardial infarction (AMI), enthusiasm for glucose lowering is tempered, in part, by concerns of inducing hypoglycemia. Yet, whether episodic hypoglycemia that occurs as a result of glucose-lowering therapy is harmful in patients with AMI is unknown. OBJECTIVE: To determine whether the mortality risk associated with hypoglycemic events is similar in patients who develop hypoglycemia spontaneously and those who develop it as a result of insulin therapy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using data from Health Facts, a contemporary database of patients hospitalized across the United States in 40 hospitals between January 1, 2000, and December 31, 2005. Of all the patients in the database, 7820 patients were hospitalized with AMI and were hyperglycemic on admission (glucose level > or = 140 mg/dL). Patients were stratified based on whether they developed a hypoglycemic event (random glucose level < 60 mg/dL) during subsequent hospitalization. Logistic regression models were used to evaluate the association between hypoglycemia and in-hospital mortality within subgroups of patients who were and were not treated with insulin therapy. MAIN OUTCOME MEASURE: All-cause in-hospital mortality. RESULTS: Among patients treated or not treated with insulin, those with hypoglycemia were older and had more comorbidity. Hypoglycemia was associated with increased mortality in patients not treated with insulin (18.4% \[25/136\] mortality in patients with hypoglycemia vs 9.2% \[425/4639\] in those without hypoglycemia; P<.001), but not in those treated with insulin (10.4% \[36/346\] mortality in patients with hypoglycemia vs 10.2% \[276/2699\] in those without hypoglycemia; P = .92). After multivariable adjustment, there was a significant interaction between hypoglycemia and insulin therapy (P value for interaction = .01). Hypoglycemia was a predictor of higher mortality in patients who were not treated with insulin (odds ratio, 2.32 \[95% confidence interval, 1.31-4.12\] vs patients without hypoglycemia), but not in patients treated with insulin (odds ratio, 0.92 \[95% confidence interval, 0.58-1.45\] vs patients without hypoglycemia). CONCLUSIONS: While hypoglycemia was associated with increased mortality in patients with AMI, this risk was confined to patients who developed hypoglycemia spontaneously. In contrast, iatrogenic hypoglycemia after insulin therapy was not associated with higher mortality risk. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/19366775) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental study.](https://www.sutterhealth.org/research/publications/std-workflow-team-care-model-improve-chronic-care-1055312331) Panattoni L, Hurlimann L, Wilson C, Durbin M, Tai-Seale M. BMC Health Serv Res. 2017 Apr 19;17(1):286. doi: 10.1186/s12913-017-2240-1. 2017 Apr 19 - Publication ### [Patients' medication-related experience of care is associated with adherence to cardiometabolic disease therapy in real-world clinical practice.](https://www.sutterhealth.org/research/publications/pt-experience-of-care-associated-with-cmd-tx-adherence-1055312299) Romanelli RJ, Huang Q, LaMori J, Doshi D, Chung S. Popul Health Manag. doi: 10.1089/pop.2017.0163. \[Epub ahead of print\] 2018 Mar 12 - Publication ### [Pharmacist-led medication management program within a patient-centered medical home.](https://www.sutterhealth.org/research/publications/pharmacist-led-medication-management-in-pcmh-1055312959) Romanelli RJ, Leahy A, Jukes T, Ishisaka DY. Am J Health Syst Pharm. 72(6):453-9. doi: 10.2146/ajhp140487. 2015 Mar 15 - Publication ### [Patient-initiated electronic messages and quality of care for patients with diabetes and hypertension in a large fee-for-service medical group: results from a natural experiment.](https://www.sutterhealth.org/research/publications/e-messages-qual-of-care-pts-dm-htn-1055312360) McClellan SR, Panattoni L, Chan AS, Tai-Seale M. Med Care. \[Epub ahead of print\] 2016 Jan 12 - Publication ### [Cost estimates for designing and implementing a novel team care model for chronically ill patients.](https://www.sutterhealth.org/research/publications/cost-estimates-to-design-implement-chronic-care-model-1055312334) Panattoni L, Dillon E, Hurlimann L, Durbin M, Tai-Seale M. J Ambul Care Manage. doi: 10.1097/JAC.0000000000000209. \[Epub ahead of print\] 2017 Sep 25 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Hypoglycemia and mortality in acute MI"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950#medicalscholarlyarticle","name":"Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction.","headline":"Hypoglycemia and mortality in acute MI","abstract":"CONTEXT: While glucose control is recommended by professional societies for patients with hyperglycemia hospitalized with acute myocardial infarction (AMI), enthusiasm for glucose lowering is tempered, in part, by concerns of inducing hypoglycemia. Yet, whether episodic hypoglycemia that occurs as a result of glucose-lowering therapy is harmful in patients with AMI is unknown. OBJECTIVE: To determine whether the mortality risk associated with hypoglycemic events is similar in patients who develop hypoglycemia spontaneously and those who develop it as a result of insulin therapy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using data from Health Facts, a contemporary database of patients hospitalized across the United States in 40 hospitals between January 1, 2000, and December 31, 2005. Of all the patients in the database, 7820 patients were hospitalized with AMI and were hyperglycemic on admission (glucose level > or = 140 mg/dL). Patients were stratified based on whether they developed a hypoglycemic event (random glucose level \u003c 60 mg/dL) during subsequent hospitalization. Logistic regression models were used to evaluate the association between hypoglycemia and in-hospital mortality within subgroups of patients who were and were not treated with insulin therapy. MAIN OUTCOME MEASURE: All-cause in-hospital mortality. RESULTS: Among patients treated or not treated with insulin, those with hypoglycemia were older and had more comorbidity. Hypoglycemia was associated with increased mortality in patients not treated with insulin (18.4% [25/136] mortality in patients with hypoglycemia vs 9.2% [425/4639] in those without hypoglycemia; P\u003c.001), but not in those treated with insulin (10.4% [36/346] mortality in patients with hypoglycemia vs 10.2% [276/2699] in those without hypoglycemia; P = .92). After multivariable adjustment, there was a significant interaction between hypoglycemia and insulin therapy (P value for interaction = .01). Hypoglycemia was a predictor of higher mortality in patients who were not treated with insulin (odds ratio, 2.32 [95% confidence interval, 1.31-4.12] vs patients without hypoglycemia), but not in patients treated with insulin (odds ratio, 0.92 [95% confidence interval, 0.58-1.45] vs patients without hypoglycemia). CONCLUSIONS: While hypoglycemia was associated with increased mortality in patients with AMI, this risk was confined to patients who developed hypoglycemia spontaneously. In contrast, iatrogenic hypoglycemia after insulin therapy was not associated with higher mortality risk.","description":"Hypoglycemia was associated with increased mortality in patients with AMI in pts who developed hypoglycemia spontaneously, not iatrogenically after insulin tx.","keywords":["Cardiovascular Diseases","Diabetes, Insulin Resistance and Metabolic Syndrome","Medical Informatics"],"datePublished":"2009-04-15","url":"https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"19366775"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1001/jama.2009.496"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/19366775/","https://doi.org/10.1001/jama.2009.496"],"isPartOf":{"@type":"Periodical","name":"JAMA"},"author":[{"@type":"Person","name":"Kosiborod M"},{"@type":"Person","name":"Inzucchi SE"},{"@type":"Person","name":"Goyal A"},{"@type":"Person","name":"Krumholz HM"},{"@type":"Person","name":"Masoudi FA"},{"@type":"Person","name":"Xiao L"},{"@type":"Person","name":"Spertus JA"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Diabetes, Insulin Resistance and Metabolic Syndrome","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/hypoglycemia-mortality-acute-mi-1055312950#breadcrumblist"}}} ```