A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality: a prospective, observational cohort study

• Published in: BMJ open Vol. 5; no. 1; p. e006794
• Main Authors: Koskela, Heikki O, Salonen, Päivi H, Romppanen, Jarkko, Niskanen, Leo
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2015; BMJ Publishing Group
• Subjects: Acute Disease; Aged; Asthma; Asthma - blood; Asthma - complications; Blood Glucose - metabolism; Body mass index; Chronic obstructive pulmonary disease; Clinical significance; Cohort analysis; Diabetes; Diabetes Mellitus - blood; Diabetes Mellitus - mortality; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Disease Progression; Family medical history; Fasting; Female; Finland; Follow-Up Studies; Glucose; Glycated Hemoglobin A - metabolism; Hemoglobin; Hospitalization; Humans; Hyperglycemia; Hyperglycemia - complications; Hypoglycemic Agents - adverse effects; Lung - pathology; Male; Medical prognosis; Middle Aged; Mortality; Observational studies; Oxygen saturation; Patients; Plasma; Prospective Studies; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - complications; Regression analysis; Respiratory Medicine; Risk Factors; Studies; Variables; Finland; RESPIRATORY MEDICINE (see Thoracic Medicine)
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2014-006794

Objective Hyperglycaemia is very common during exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, its clinical significance is not clear. The objective of the present study was to assess whether exacerbation-associated hyperglycaemia affects long-term mortality in these patients. Design A prospective, observational cohort study. Setting A single hospital in eastern Finland. Participants 153 consecutive patients who were hospitalised due to mild to moderate obstructive lung disease exacerbation (110 with asthma and 43 with COPD) and who survived at least 30 days. Interventions Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The median follow-up time was 6 years and 2 months. Results During the follow-up, 57 (37%) of the patients died. Previously diagnosed diabetes was strongly associated with elevated mortality (adjusted HR (aHR) 3.03 (1.28 to 7.18). The highest fasting glucose value (aHR 1.10 (1.01 to 1.20) per 1 mmol/L) and the highest postprandial glucose value ((aHR 1.07 (1.00 to 1.16)) were also associated with late mortality. However, the associations between highest glucose values and mortality vanished when the diagnosis of diabetes was included in the same model. Within the patients without diabetes, neither fasting (aHR 0.92 (0.42 to 2.02)) nor postprandial ((aHR 1.04 (0.50 to 2.12)) hyperglycaemia was associated with late mortality. There were no statistically significant differences in the underlying causes of death between the patients with and without diabetes. Conclusion A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality.