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Mortality risk higher for older adults with diabetes, hyperglycemic crisis episodes
A higher risk for mortality was found among older adults with diabetes who experienced hyperglycemic crisis episodes compared with those who did not experience such episodes, according to study findings published in Diabetes Care.
How-Ran Guo, MD, ScD, of National Cheng Kung University in Taiwan, and colleagues evaluated data from Taiwan’s National Health Insurance Database for 13,551 older patients with new-onset diabetes between 2000 and 2002, including 34,517 with hyperglycemic crisis episodes and 9,034 without (controls). Follow-up was conducted until 2011.
Participants were classified into three subgroups: young elderly (65-74 years), moderately elderly (75-84 years) and old elderly (≥ 85 years). After matching patients with and without hyperglycemic crisis episodes, no significant differences were found for hypertension, renal disease, coronary artery disease, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure or liver disease.
Overall, more patients with such episodes died (36.17%) compared with controls (18.73%) during follow-up. Similarly, the risk for mortality was greater among those with hyperglycemic crisis compared with controls in the first 6 years of follow-up: first month after hyperglycemic episode (incidence rate ratio [IRR] = 26.56; 95% CI, 17.97-39.27), 1 to 6 months after (IRR = 4.54; 95% CI, 3.64-5.67), 6 to 12 months after (IRR = 2.63; 95% CI, 2.07-3.33), 1 to 2 years after (IRR = 1.81; 95% CI, 1.48-2.2), 2 to 4 years after (IRR = 1.89; 95% CI, 1.63-2.18) and 4 to 6 years after (IRR = 1.49; 95% CI, 1.23-1.81). No significant difference in mortality was found after 6 years.
Compared with controls, during follow-up those with hyperglycemic crisis had significantly lower rates of survival (P < .0001); this finding was more profound with two or more episodes.
Controls in the old elderly group had the highest IRR, followed by those in the young elderly group and moderately elderly group.
Participants who had experienced hyperglycemic crisis had higher rates of mortality when they had hypertension, renal disease, CAD, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure or liver disease compared with controls with the same comorbid conditions for hypertension.
“In summary, [hyperglycemic crisis episodes] signified uncontrolled diabetes, which may have long-term effects that contribute to various complications, including death,” the researchers wrote. “Early referral of geriatric patients with diabetes and [hyperglycemic crisis episodes] for proper education, better access to medical care, effective communication with a health care provider and control of comorbidities may be urgently needed.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.