Nardeen S. Habashy

Background: Hospital inpatient hypoglycaemia is a common complication associated with poor patient outcomes. With the rising prevalence of diabetes mellitus (DM) and approximately 20% of hospital beds occupied by patients with DM, inpatient hypoglycaemia is an important safety concern. We aimed to determine the incidence of and risk factors for inpatient hypoglycaemia and their association with mortality and hospital length of stay (LOS). Methods: A retrospective single-centre case–control study was conducted at Nepean Hospital, New South Wales, Australia, over 12 months (July 2018–June 2019). The cases were inpatients who experienced hypoglycaemia, defined as capillary blood glucose <4 mmol/L. Patients with hypoglycaemia were stratified into those with and without DM. The controls were randomly selected inpatients with DM admitted during the same period who did not experience hypoglycaemia. Results: A total of 251 episodes of hypoglycaemia occurred in 234 patients; 202 events (80%) occurred in 187 patients with DM and 49 (20%) in 47 patients without DM. In the patients with DM, the factors associated with hypoglycaemia included basal–bolus insulin (aOR 26.6; 95% CI 7.9–106.6), premixed insulin (aOR 5.9; 95% CI 1.6–25.9), sulfonylureas (aOR 3.2; 95% CI 1.1–9.6), and malnutrition (aOR 4.2; 95% CI 1.2–18.0). Compared with the controls, patients with DM and hypoglycaemia had higher inpatient mortality (10.2% vs. 3.0%), 12-month mortality (20.9% vs. 5.5%), and a longer median LOS (12 vs. 4 days). The twelve-month mortality was 36.2% in patients without DM who experienced hypoglycaemia. Conclusions: Inpatient hypoglycaemia is associated with high mortality and increased LOS, highlighting the need for greater awareness and effective prevention strategies.

Background: Metabolic and bariatric surgery (MBS) is used to achieve significant and sustained weight loss. Considerable MBS are performed on women of reproductive age, with limited data regarding risks and management pre-conception and peripartum. Methods: Our retrospective audit assessed adult women in pregnancy with prior MBS, attending a specialised, multidisciplinary obesity service between January 2018 and July 2022. Baseline clinical and demographic characteristics, including surgical data, anthropometry, nutritional status, and pregnancy outcomes were collected for each pregnancy and evaluated. Results: Across 189 women and 210 pregnancies, pre-pregnancy obesity (BMI ≥ 30) prevalence was 55.9%, with polycystic ovarian syndrome and type 2 diabetes and depression and anxiety the most common associated medical and mental health problems, respectively. One-sixth of pregnancies were conceived within 12 months of MBS. Of those with available data ( n = 174), only 43.1% ( n = 75) had preconception dietitian reviews. Second trimester iron deficiency was noted in 64.1% (107/167) (parenteral supplementation required in 23.8% (50/210)) and vitamin B12 deficiency in 46.2% (61/132) (parenteral supplementation administered in 32.9% (69/210)). Maternal and neonatal complications occurred in 43.8% and 45.7% of pregnancies. Special care nursery (SCN) or neonatal intensive care unit (NICU) admissions were higher than background population rates. Conclusions: Women in pregnancy following MBS have complex medical and mental health backgrounds, limited pre-conception counselling and significant nutritional deficiencies, with higher rates of SCN/NICU admissions. Our study highlights the role of specialised pre-conception and perinatal services for these women.