The Canadian Hypoglycemia During Hospitalization Score Is Externally Valid in the Australian Diabetes IN-hospital: Glucose & Outcomes (DINGO) Cohort

Lauren Di Salvo; Rahul D Barmanray; Evelyn Andrews; Mervyn Kyi; Timothy N Fazio; Julia Lowe; Spiros Fourlanos

doi:10.1016/j.jcjd.2024.04.010

The Canadian Hypoglycemia During Hospitalization Score Is Externally Valid in the Australian Diabetes IN-hospital: Glucose & Outcomes (DINGO) Cohort

Can J Diabetes. 2024 Apr 23:S1499-2671(24)00089-3. doi: 10.1016/j.jcjd.2024.04.010. Online ahead of print.

Authors

Lauren Di Salvo¹, Rahul D Barmanray², Evelyn Andrews¹, Mervyn Kyi², Timothy N Fazio³, Julia Lowe⁴, Spiros Fourlanos⁵

Affiliations

¹ Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
² Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Victoria, Australia.
³ Health Intelligence Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁴ Eastbrooke Family Clinic Southport, Southport, Queensland, Australia.
⁵ Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: spiros.fouranos@mh.org.au.

PMID: 38663790
DOI: 10.1016/j.jcjd.2024.04.010

Abstract

Objectives: The Hypoglycemia During Hospitalization (HyDHo) score predicts hypoglycemia in a population of Canadian inpatients by assigning various weightings to 5 key clinical criteria known at the time of admission, in particular age, recent presentation to an emergency department, insulin use, use of oral hypoglycemic agents, and chronic kidney disease. Our aim in this study was to externally validate the HyDHo score by applying this risk calculator to an Australian population of inpatients with diabetes.

Methods: This study was a retrospective data analysis of a subset of the Diabetes IN-hospital: Glucose & Outcomes (DINGO) cohort. The HyDHo score was applied based on clinical information known at the time of admission to stratify risk of inpatient hypoglycemia.

Results: The HyDHo score was applied to 1,015 patients, generating a receiver-operating characteristic c-statistic of 0.607. A threshold of ≥9, as per the original study, generated a sensitivity of 83% and specificity of 20%. A threshold of ≥10, to better suit this Australian population, generated a sensitivity of 90% and specificity of 34%. The HyDHo score has been externally valid in a geographically different population; in fact, it outperformed the original study after accounting for local hypoglycemia rates.

Conclusions: Our findings support the external validity of the HyDHo score in a geographically different population. Application of this simple and accessible tool can serve as an adjunct to predict an inpatient's risk of hypoglycemia and guide more appropriate glucose monitoring and diabetes management.

Keywords: Hypoglycémie; diabetes; diabète; en milieu hospitalier; external validity; hospitalisation; hospitalization; hypoglycemia; in-hospital; outil de prédiction du risque; risk prediction tool; validité externe.