Glucose levels at hospital admission are associated with 5 year mortality

N Wah Cheung; Patrick McElduff; Greg Fulcher; Sandy Middleton; Roger Chen; Barbara Depczynski; Jeff Flack; Jen Kinsella; Margaret Layton; Mark McLean; Ann Poynten; Katherine Tonks; Chris White; Vincent Wong; David R Chipps

doi:10.1016/j.diabres.2024.111840

Glucose levels at hospital admission are associated with 5 year mortality

Diabetes Res Clin Pract. 2024 Nov:217:111840. doi: 10.1016/j.diabres.2024.111840. Epub 2024 Aug 30.

Authors

N Wah Cheung¹, Patrick McElduff², Greg Fulcher³, Sandy Middleton⁴, Roger Chen⁵, Barbara Depczynski⁶, Jeff Flack⁷, Jen Kinsella⁸, Margaret Layton⁹, Mark McLean¹⁰, Ann Poynten¹¹, Katherine Tonks¹², Chris White¹³, Vincent Wong¹⁴, David R Chipps¹⁵

Affiliations

¹ Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].
² University of Newcastle, Newcastle, NSW, Australia. Electronic address: [email protected].
³ Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
⁴ St Vincent's Health Australia, Sydney, NSW, Australia; Australian Catholic University, School of Nursing, Midwifery and Paramedicine Sydney, Australia. Electronic address: [email protected].
⁵ Dept of Diabetes & Endocrinology, Concord Repatriation General Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
⁶ Diabetes & Endocrinology Service, Liverpool Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
⁷ Dept of Diabetes & Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
⁸ Ryde Hospital Diabetes Service, Sydney, NSW, Australia. Electronic address: [email protected].
⁹ Dept of Diabetes & Endocrinology, Gosford Hospital, Gosford, NSW, Australia. Electronic address: [email protected].
¹⁰ Dept of Diabetes & Endocrinology, Blacktown Hospital, Sydney, NSW, Australia; Western Sydney University School of Medicine, Penrith, NSW, Australia. Electronic address: [email protected].
¹¹ Dept of Diabetes & Endocrinology, Prince of Wales Private Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
¹² Garvan Institute of Medical Research, Sydney, NSW, Australia. Electronic address: [email protected].
¹³ Dept of Diabetes & Endocrinology, Prince of Wales Private Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
¹⁴ Diabetes & Endocrinology Service, Liverpool Hospital, Sydney, NSW, Australia. Electronic address: [email protected].
¹⁵ Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].

PMID: 39216794
DOI: 10.1016/j.diabres.2024.111840

Abstract

Aim: We aimed to determine if hospital admission hyperglycaemia and hypoglycaemia are associated with increased long-term mortality.

Methods: 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.

Results: 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.

Conclusion: Hyperglycaemia and hypoglycaemia on hospital admission are associated with increased long-term mortality.

Keywords: Diabetes; Glucose; Hospital; Hyperglycaemia; Survival analysis.

MeSH terms

Aged
Blood Glucose* / analysis
Female
Hospitalization* / statistics & numerical data
Humans
Hyperglycemia* / blood
Hyperglycemia* / mortality
Hypoglycemia* / mortality
Male
Middle Aged
Patient Admission / statistics & numerical data

Substances

Blood Glucose