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BMJ Open Diabetes Res Care. 2018 Dec 18;6(1):e000607. doi: 10.1136/bmjdrc-2018-000607. eCollection 2018.

Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes.

Author information

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA.
Contributed equally



The frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.


We determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.

Research design and methods:

Prospective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.


Among 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4-14) vs 7 days (IQR 5-15), p=0.92)) between groups.


Asymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.


complications; glycemic control; hospitalization; inpatient diabetes management

Conflict of interest statement

Competing interests: GEU is partly supported by research grants from the Public Health Service (grants UL1 TR002378 from the Clinical and Translational Science Award program and 1P30DK111024-01 from the National Institutes of Health and National Center for Research Resources). PV is supported by NIH grant: 3K12HD085850-03S1. GEU has received unrestricted research support for inpatient studies (to Emory University) from Merck, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Sanofi. FJP and PV have received consulting fees from Boehringer Ingelheim and Merck. RJG has received unrestricted research support for inpatient studies (to Emory University) from Novo Nordisk and consulting fees from Abbott. SC, PCG, IA, CR, MAU, JSH, MF, and HW declared no conflicts of interest.

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