Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study

Abstract

OBJECTIVEHyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE. RESEARCH DESIGN AND METHODSThis retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011. RESULTSOne thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97-39.27) and remained higher until 4-6 years after the HCE (IRR 1.49; 95% CI 1.23-1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors. CONCLUSIONSPatients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.

Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study

“…The major difference of long-term mortality after HCE between non-elderly and elderly was that HCE significantly increases the subsequent mortality risk even more than 8 years in the non-elderly but limited to B6 years in the elderly [15]. The elderly have more comorbidites which may dilute the HCE effect on the long-term mortality after 6 years.…”

“…The long-term effect of uncontrolled diabetes contributes to various complications, including death [1]. A study showed that geriatric patients (C65 years) with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up [15]. However, the subsequent mortality of the non-elderly (\65 years) after HCE has never been clarified.…”

Diabetes and Aging: Unique Considerations and Goals of Care

“…Long-term mortality after hyperglycemic crises are significantly higher in older adults (23). In the Perspective by Korytkowski and Forman (24), the authors point out that although older adults are at higher risk of atherosclerotic cardiovascular disease, most of the studies examining the benefits for aggressive glucose-lowering and cardiovascular risk factor modification (i.e., lipid-lowering, hypertension, and antiplatelet therapies) are in nonelderly adults.…”

330 Bidirectional Relationship Between Diabetes and Acute Pancreatitis: A Population-Based Cohort Study in Taiwan

“…Diabetes with poor compliance was defined as a hospitalization with the diagnosis of a hyperglycemic crisis episode (HCE) (ICD-9-CM codes: diabetic ketoacidosis, 250.1 or hyperosmolar hyperglycemic state, 250.2). 24 The index date for each diabetic patient was the date of his or her first diabetes diagnosis. The index date for subjects in the unexposed group was set as January 1,2005.…”

“…4,23,38,39 Second, laboratory findings relevant to the severity of diabetes, including HbA1c and blood glucose values, were unavailable in the database. Alternatively, since uncontrolled diabetes is the most common factor precipitating HCE, 24 diabetes with poor compliance was defined as diabetes with at least one episode of HCE. Because diabetic ketoacidosis and the hyperosmolar hyperglycemic state are extremely severe states, they may not serve as perfect substitutes for poor control.…”