Glucose levels at hospital admission are associated with 5 year mortality

• Published in: Diabetes research and clinical practice Vol. 217; p. 111840
• Main Authors: Cheung, N. Wah, McElduff, Patrick, Fulcher, Greg, Middleton, Sandy, Chen, Roger, Depczynski, Barbara, Flack, Jeff, Kinsella, Jen, Layton, Margaret, McLean, Mark, Poynten, Ann, Tonks, Katherine, White, Chris, Wong, Vincent, Chipps, David R
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2024
• Subjects: Aged; Blood Glucose - analysis; Diabetes; Female; Glucose; Hospital; Hospitalization - statistics & numerical data; Humans; Hyperglycaemia; Hyperglycemia - blood; Hyperglycemia - mortality; Hypoglycemia - mortality; Male; Middle Aged; Patient Admission - statistics & numerical data; Survival analysis; Survival analysis; Hyperglycaemia; Diabetes; Glucose; Hospital
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2024.111840

•Hyperglycaemia and hypoglycaemia at the point of hospital admission are associated with increased long-term mortality beyond the period of hospitalisation.•For patients with hyperglycaemia, identification that they had diabetes whilst in hospital was associated with lower long-term mortality than for people where the diagnosis of diabetes was not made. We aimed to determine if hospital admission hyperglycaemia and hypoglycaemia are associated with increased long-term mortality. A post-hoc analysis of data from a trial of glucose screening in the emergency department was conducted. Data were linked with a death registry up to 5 years after admission. The relationship between admission glucose and mortality was examined by cox regression. Further analyses of people who survived the admission and subsequent 28 days was performed. There were 131,322 patients, of whom 38,712 (29.5 %) died. Mean follow-up was 3·3 ± 1·5 years. Compared to the reference glucose band of 6·1-8·0 mmol/L, there was increased mortality in higher bands, reaching a hazard ratio (HR) of 1·44 (95 %CI 1·34-1·55, p < 0·001) for people with glucose > 20·0 mmol/L. The HR was 1·56 (95 %CI 1·46-1·68, p < 0·001) for people with glucose ≤ 4·0 mmol/L. Similar relationships were observed among 28-day survivors. The relationships were attenuated among people with known diabetes. Among 4867 subjects with glucose ≥ 14·0 mmol/L, those diagnosed with diabetes during the admission had lower mortality compared to subjects where the diagnosis was not made (HR 0·53, 95 %CI 0·40-0·72, p < 0·001). This was attenuated among 28-day survivors. Hyperglycaemia and hypoglycaemia on hospital admission are associated with increased long-term mortality.