• Joanna F M Dharma, Christine Polmear, Spiros Fourlanos, and Mervyn Kyi.
• Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia.
• Intern Med J. 2024 Mar 1; 54 (3): 430437430-437.

Background And AimsGiven treatment-related hypoglycaemia in hospitals can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as a reportable hospital-acquired complication (HAC) with financial disincentives. However, the designation of a hypoglycaemia HAC relies on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of a hypoglycaemia HAC.MethodsWe performed a retrospective review on patients discharged from the Northern Health hospitals between March and August 2021 who were designated as experiencing a hypoglycaemia HAC. We assessed cases for biochemical validity (glucose <4.0 mmol), clinical context and whether they were treatment-related (treatment with insulin or sulphonylurea). We then compared this cohort with a hospital-wide glucometric survey based on a point-prevalence study to determine the proportion of individuals with hypoglycaemic events that were designated as hypoglycaemia HAC.ResultsTwo hundred fifty-six admissions were coded as hypoglycaemia HAC. Eleven (4%) did not have a biochemically valid episode. Of the valid cases, 34 (14%) were not treated with any glucose-lowering medication and 11 (4%) were treated with noninsulin, nonsulphonylurea glucose-lowering medication. Two hundred admissions (78%) were considered treatment-related HAC. Of 139 individuals with diabetes identified in the hospital-wide point-prevalence study, 25 (18%) had biochemical evidence for hypoglycaemia: 22 were treatment-related, of which 68% were not coded as HAC.ConclusionGiven safety and cost implications, the designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care.© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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