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Hyperglycemia increases mortality risk, independent of type 2 diabetes

Stethoscope and a syringe on a diabetes test

Hyperglycemia is associated with a higher likelihood for mortality, and the odds are greater for adults without diabetes and for those meeting type 2 diabetes targets, according to study data.

“We found that admission hyperglycemia was a significant and independent risk factor for mortality among all hospitalized patients, regardless of baseline glycemic status,” Hanaa Rayyan-Assi, MSc, of the Clalit Research Institute, Chief Physician’s Office, Tel Aviv, Israel, and colleague wrote in a study published in Diabetes/Metabolism Research and Reviews. “However, baseline glycemic status did modify this association; those without type 2 diabetes with inpatient hyperglycemia were at greater risk for mortality than those with type 2 diabetes. These results were consistent, regardless of severity of admission, and were valid also for those hospitalized outside of the ICU. Additionally, patients with controlled type 2 diabetes prior to hospitalization were at greater risk for mortality than those with uncontrolled type 2 diabetes.”

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Researchers conducted a retrospective cohort study of 174,671 adults (mean age, 68.7 years; 50.2% men) admitted overnight to one of Clalit Health Services’ eight inpatient wards from 2012 to 2015. All participants were aged 45 years or older, had a glucose test during hospitalization, were not pregnant, did not have an active malignancy or stage 5 chronic kidney disease, and were not transferred to another facility. The study population was divided into four groups based on baseline glycemic status: type 2 diabetes, prediabetes, adults without type 2 diabetes and unscreened. Researchers assessed mortality from the date of hospital admission until 30 days after discharge.

Of the study population, 77% did not develop hyperglycemia during hospitalization. In the cohort without hyperglycemia, 36.7% did not have type 2 diabetes and 33.3% had type 2 diabetes. Of those who had hyperglycemia, 51.8% had been diagnosed with type 2 diabetes.

In the total study population, 4.3% died either during hospitalization or 30 days after discharge. A higher percentage of adults in the hyperglycemia group died compared with those without hyperglycemia (7.8% vs. 3.3%; P < .001).

After controlling for baseline glycemic status, hyperglycemia was associated with increased odds of mortality (adjusted OR = 2.19; 95% CI, 2.08-2.31). When compared with the type 2 diabetes group, adults with prediabetes had a lower likelihood of death (aOR = 0.92; 95% CI, 0.86-0.98). However, the unscreened group (aOR = 1.41; 95% CI, 1.26-1.58) and those without type 2 diabetes (aOR = 1.12; 95% CI, 1.05-1.2) had higher odds for mortality when compared with the type 2 diabetes cohort.

When analyzing only individuals with type 2 diabetes, those who had hyperglycemia had a higher likelihood for mortality (aOR = 1.45; 95% CI, 1.22-1.73). Participants with controlled type 2 diabetes had a higher mortality risk than those with uncontrolled type 2 diabetes, beyond the increased odds from the presence of hyperglycemia (aOR = 1.62; 95% CI, 1.33-1.97).

“Understanding the role of type 2 diabetes predisposition in the association between inpatient hyperglycemia and mortality is critical in risk assessment of short-term mortality following admission,” the researchers wrote. “The findings indicate that identifying baseline glycemic status and inpatient hyperglycemia status on admission may help the medical staff foresee potential excess risk of mortality prior to the first day of admission and following discharge. Additionally, controlled type 2 diabetes with hyperglycemia may benefit from lower glucose targets during hospitalization.”