Hypoglycemia and Clinical Outcomes in Non-Diabetic Adults Hospitalized with Acute Infection.

BACKGROUND

Hypoglycemia in hospitalized adults without diabetes is often considered incidental, but acute infection may disrupt glucose homeostasis.

AIMS: To determine the incidence of hypoglycemia in adults without diabetes hospitalized for acute infection and evaluate its association with clinical outcomes.

METHODS

We conducted a retrospective cohort study of 64,871 adults without diabetes admitted for acute infection between 2010 and 2025 at a tertiary academic center. Patients with diabetes or prior glucose-lowering therapy were excluded. Mild hypoglycemia was defined as 55-69 mg/dL and severe hypoglycemia as < = 54 mg/dL. Outcomes included 30 and 90 d mortality, clinical deterioration, and ICU admission.

RESULTS

Hypoglycemia occurred in 8,827 patients (13.6%): 5,684 (8.8%) had mild and 3,143 (4.8%) had severe hypoglycemia. Mortality increased by hypoglycemia severity. For 90 d mortality, adjusted odds ratios (aORs) were 1.30 (95% CI, 1.20-1.42; p <0.001) for mild and 1.73 (95% CI, 1.57-1.91; p <0.001) for severe hypoglycemia. For 30 d mortality, aORs were 1.19 (95% CI, 1.07-1.33; p <0.001) and 1.70 (95% CI, 1.51-1.91; p <0.001), respectively. Achievement of subsequent normoglycemia following hypoglycemia was associated with lower observed mortality, whereas transition to hyperglycemia was associated with worse outcomes.

CONCLUSIONS

In adults without diabetes hospitalized for acute infections, hypoglycemia is common and associated with mortality in a severity-dependent manner. Glycemic overshoot after correction may identify an additional high-risk state, supporting careful glucose monitoring and controlled correction during acute illness.