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One‐ and five‐year risk of death and cardiovascular complications for hospitalized patients with hyperglycemia without diagnosed diabetes: An observational study
Author(s) -
Tuna Meltem,
Manuel Douglas G.,
Bennett Carol,
Lawrence Nadine,
Walraven Carl,
Keely Erin,
Malcolm Janine,
D. Reid Robert,
Forster Alan J.
Publication year - 2014
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2181
Subject(s) - medicine , observational study , diabetes mellitus , intensive care medicine , hospital medicine , emergency medicine , medline , pediatrics , endocrinology , political science , law
BACKGROUND Hyperglycemia is recognized as an important threat to the health of patients, independent of diabetes status. However, no long‐term follow‐up study of patients with in‐hospital elevated glucose without diabetes has been conducted. OBJECTIVE To compare 1‐ and 5‐year risk of death and cardiovascular (CV) complications in patients with a diagnosis of diabetes versus those without a diabetes diagnosis DESIGN Retrospective cohort study. METHODS Risk of all‐cause death and CV complications (acute myocardial infarction [AMI], congestive heart failure [CHF], cardiovascular disease [CVD], peripheral vascular disease [PVD], and end‐stage renal disease [ESRD]) in those diagnosed with diabetes versus those with different glycemia categories was determined using competing risk models. SETTING/PATIENTS All adult patients from a tertiary hospital discharged alive between 1996 and 2008 from any service except psychiatry or obstetrics. RESULTS Compared to patients with diagnosed diabetes, patients with peak serum glucose level >200 mg/dL had significantly higher 1‐year risk (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.20‐1.43) and 5‐year risk (HR: 1.13, 95% CI: 1.06‐1.22) of death but a decreased 1‐year risk of hospitalization for CHF (HR: 0.71, 95% CI: 0.62‐0.81), PVD (HR: 0.20, 95% CI: 0.18‐0.24), or ESRD (HR: 0.73, 95% CI: 0.6‐0.89). There was no risk difference for AMI (HR: 0.96, 95% CI: 0.78‐1.18) or CVD (HR: 0.79, 95% CI: 0.61‐1.0). CONCLUSIONS Although it is unclear whether hospitalized patients with elevated peak serum glucose have early diabetes or their hyperglycemia reflects hospital stress or another comorbidity, in‐hospital hyperglycemia is an important clinical indicator, carrying a higher 1‐ and 5‐year mortality risk than those with diagnosed diabetes. Journal of Hospital Medicine 2014;9:365–371. © 2014 Society of Hospital Medicine