The Association between Inpatient Hyperglycemia and Thirty-Day Mortality Is Modified by Type 2 Diabetes History
Authors: ASSI HANA'A RAYYAN , FELDMAN BECCA S. , LEVENTER-ROBERTS MAYA , RAZ ITAMAR 
Published: June 2018

Background: There is a well-established association between inpatient hyperglycemia (HG) and mortality. However, evidence is inconsistent regarding whether this association is differential among those with and without type 2 diabetes mellitus (T2DM). Most studies results are limited by selected patient populations and many did not adjust for comorbidities. We aimed to examine if the association between inpatient HG and 30-day mortality is modified by T2DM status among a population-based cohort with over 15 years of medical history.

Methods: A retrospective cohort study of individuals who were first hospitalized between 2012-2015. Thirty-day mortality was assessed during the inpatient stay up to 30 days post discharge. The adjusted association between inpatient HG and mortality was first assessed with logistic regression models. Then, four interaction terms were entered into the model to assess if the association of HG with mortality significantly differed by pre-hospital glycemic status (T2DM, prediabetes, unscreened and non-T2DM).

Results: The multivariate model demonstrated a 2.18-fold risk of mortality associated with HG (OR [95% CI]: 2.18 [2.07-2.29]). After including the interaction terms between HG and pre-hospital glycemic status the model yielded the following results: the odds of mortality, compared to T2DM group with HG, were 1.43 [1.27-1.62] in non-T2DM group, 1.32 [1.16-1.52] in prediabetes group, and 1.28 [1.02-1.60] in unscreened group. This relationship remained robust throughout all sensitivity analyses that we conducted.

Conclusion: The findings indicate that inpatient HG is positively associated with mortality and the group without T2DM is at highest risk. Glucose targets should be reconsidered for this group during their inpatient stay and their transition to the outpatient setting needs to be more closely monitored. Prospective research is needed to examine the efficacy of lowering their glucose targets on short-term mortality.

Disclosure

H. Rayyan Assi: None. B.S. Feldman: None. M. Leventer-Roberts: None. I. Raz: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Stock/Shareholder; Self; DarioHealth. Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Orgenesis Inc., Pfizer Inc., Sanofi R&D, SmartZyme Biopharma. Consultant; Self; Bristol-Myers Squibb Company. Speaker's Bureau; Self; Bristol-Myers Squibb Company, Johnson & Johnson Diabetes Institute, LLC., Merck Sharp & Dohme Corp., Novartis Pharma K.K., Sanofi-Aventis. Consultant; Self; FuturRx Ltd, Insuline Medical,Camereyes Ltd, Exscopia, Medial EarlySign Ltd. Stock/Shareholder; Self; Glucome Ltd, InsuLine Medical Ltd.. Consultant; Self; Dermal Biomics Inc. Stock/Shareholder; Self; Orgenesis Inc.. Speaker's Bureau; Self; Teva Pharmaceutical Industries Ltd.. Advisory Panel; Self; Concenter BioPharma/Silkim Ltd, Camereyes Ltd. Stock/Shareholder; Self; CameraEyes Ltd. Advisory Panel; Self; Breath of Life PharmaLtd, Panaxia.