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Outcomes for general medical inpatients with diabetes mellitus and new hyperglycaemia
Author(s) -
Baker Scott T,
Chiang Cherie Y,
Zajac Jeffrey D,
Bach Leon A,
Jerums George,
MacIsaac Richard J
Publication year - 2008
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2008.tb01650.x
Subject(s) - medicine , diabetes mellitus , odds ratio , tertiary referral hospital , prospective cohort study , cohort , cohort study , referral , retrospective cohort study , endocrinology , family medicine
Objectives: To investigate the relationship between admission glycaemic status and inpatient mortality in patients with and without pre‐existing diabetes. Design: Prospective observational cohort study. Setting: A general medical ward in an Australian tertiary referral hospital. Participants: 903 patients admitted to the general medical ward between February 2003 and July 2004. Main outcome measure: Inpatient death. Results: The overall inpatient mortality was 5.4% ( n = 49). In the total cohort, age > 75 years and admission fasting plasma glucose (FPG) levels ≥ 5.6 mmol/L were independent predictors of mortality. For patients without a known history of diabetes, each 1 mmol/L rise in admission FPG was associated with a 33% increase in mortality. In these patients, elevated (> 6.0%) and normal glycated haemoglobin (HbA 1c ) levels were associated with mortalities of 11.3% and 4.4%, respectively (odds ratio, 2.47; 95% CI, 1.16–5.26). In contrast, in patients with known diabetes, there was no association between admission FPG levels, HbA 1c and mortality. Length of stay was not independently associated with FPG, HbA 1c , or diabetes status. Conclusions: In patients without known diabetes, the risk of death was increased for admission FPG levels ≥ 5.6 mmol/L. However, pre‐existing abnormal glucose metabolism, reflected by elevated HbA 1c levels, appeared a more important predictor of inpatient mortality than glucose levels in patients without known diabetes.