Advertisement

Effect of short- and long-term diabetes control on in-hospital and one year mortality rates in hospitalized patients with diabetic foot

Published:January 10, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.013

      Highlights

      • Improved glucose control during admission was associated with a significant reduction of one year mortality rates.
      • Adequate long term diabetes control wasn’t associated with reduced length of hospital stay or rate of readmissions.
      • Adequate diabetes control during hospitalization didn’t affect the length of hospital stay or the rate of readmission.

      Abstract

      Introduction

      It remains unclear whether diabetic patients with diabetic foot complications benefit from strict glycemic control during hospitalization The present study investigates the effect of short- and long-term diabetes control on hospital outcomes including: in-hospital and one year mortality rates, length of hospital stay and the rate of repeated admissions.

      Methods

      Type 2 diabetic patients (n = 341) were hospitalized for diabetic foot complications at Wolfson Medical Center over a 5 year period (2008–2012). The adequate short-term glycemic control was defined as average glucose levels between 110 and 180 mg/dL. HbA1c values below 7% were defined as adequate long–term glycemic control.

      Results

      The average glucose levels during hospitalization were 179 ± 45 mg/dL and 40% of the measurements were between 110 and 180 mg/dL. Mean admission HBA1c levels were 8.43% ± 2.26%, and 31% of the values were below 7%. The mean length of hospital stay was 24.3 ± 22.6 days, 15.0% of the patients needed surgical intervention during admission, the in-hospital mortality rate was 10.3%, and the rate of 1-year readmission was 25.1%. Adequate diabetes control during hospitalization was not significantly associated with reduced in-hospital mortality (hazard ratio, 0.454, 95% confidence interval 0.186–1.103, p = 0.081). However, adequate diabetes control during hospitalization lead to significantly decreased one year mortality (hazard ratio, 0.269, 95% confidence interval 0.707–0.101, p = 0.009). Adequate diabetes control during hospitalization did not affect the length of hospital stay or the rate of repeated admission.

      Conclusions

      Improved glucose control during hospital admission (levels between 110 and 180 mg/dL) was associated with reduction of one year mortality.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • UK Prospective Diabetes
        Study (UKPDS) GroupIntensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
        Lancet. 1998; 352: 837-853
        • Gaede P.
        • Lund-Andersen H.
        • Parving H.H.
        • Pedersen O.
        Effect of a multifactorial intervention on mortality in type 2 diabetes.
        N Engl J Med. 2008; 358: 580-591
        • Holman R.R.
        • Paul S.K.
        • Bethel M.A.
        • Matthews D.R.
        • Neil H.A.
        10-year follow-up of intensive glucose control in type 2 diabetes.
        N Engl J Med. 2008; 359: 1577-1589
        • American Diabetes Association
        Standards of medical care in diabetes–2012.
        Diabetes Care. 2012; 35: S11-S63
        • Inzucchi S.E.
        • Bergenstal R.M.
        • Buse J.B.
        • et al.
        Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
        Diabetologia. 2012; 55: 1577-1596
        • Dluhy R.G.
        • McMahon G.T.
        Intensive glycemic control in the ACCORD and ADVANCE trials.
        N Engl J Med. 2008; 358: 2630-2633
        • Boulton A.J.
        The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metabol.
        Res Rev. 2008; 24: S3-S6
        • Gershater M.A.
        • Londahl M.
        • Nyberg P.
        • et al.
        Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study.
        Diabetologia. 2009; 52: 398-407
        • Prompers L.
        • Huijberts M.
        • Apelqvist J.
        • et al.
        High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study.
        Diabetologia. 2007; 50: 18-25
        • Fagher K.
        • Löndahl M.
        The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers.
        Diabetologia. 2013; 56: 1140-1147
        • Svensson Ann-Marie
        • McGuire Darren K.
        • Abrahamsson Putte
        • Dellborg Mikael
        Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events.
        Eur Heart J. 2005; 26: 1255-1261
        • Britton K.A.
        • Aggarwal V.
        • Chen A.Y.
        • et al.
        No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction.
        Am Heart J. 2011; 2011: 657-663
        • Riddle M.C.
        • Ambrosius W.T.
        • Brillon D.J.
        • et al.
        Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial.
        Diabetes Care. 2010; 33: 983-990
        • Fuller J.H.
        • Shipley M.J.
        • Rose G.
        • Jarrett R.J.
        • Keen H.
        Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study.
        BMJ (Clin Res Ed). 1983; 287: 867-870
        • Coutinho M.
        • Gerstein H.C.
        • Wang Y.
        • Yusuf S.
        The relationship between glucose and incident cardiovascular events. A meta-regression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.
        Diabetes Care. 1999; 22: 233-240
        • O'Sullivan J.J.
        • Conroy R.M.
        • Robinson K.
        • Hickey N.
        • Mulcahy R.
        In-hospital prognosis of patients with fasting hyperglycaemia after first myocardial infarction.
        Diabetes Care. 1991; 14: 758-760
        • Umpierrez G.E.
        • Isaacs S.D.
        • Bazargan N.
        • You X.
        • Thaler L.M.
        • Kitabchi A.E.
        Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.
        J Clin Endocrinol Metab. 2002; 87: 978-982
        • Kosiborod M.
        • Rathore S.S.
        • Inzucchi S.E.
        • et al.
        Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes.
        Circulation. 2005; 111: 3078-3086
        • Wiener R.S.
        • Wiener D.C.
        • Larson R.J.
        Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.
        JAMA. 2008; 300: 933-944
        • Rizzoni D.
        • Porteri E.
        • Guelfi D.
        • et al.
        Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non-insulin-dependent diabetes mellitus.
        Circulation. 2001; 103: 1238-1244
        • Brownlee M.
        • Cerami A.
        • Vlassara H.
        Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications.
        N Engl J Med. 1998; 318: 1315-1321
        • Nickenig G.
        • Roling J.
        • Strehlow K.
        • Schnabel P.
        • Bohm M.
        Insulin induces upregulation of vascular AT1 receptor gene expression by posttranscriptional mechanisms.
        Circulation. 1998; 98: 2453-2460
        • Montagnani M.
        • Quon M.J.
        Insulin action in vascular endothelium: potential mechanisms linking insulin resistance with hypertension.
        Diabetes Obes Metab. 2000; 2: 285-292
        • Lysyy L.
        • Ovadia S.
        • Zudkov T.
        • Koper I.
        • Zandman-Goddard G.
        Infections in diabetic patients - a two year experience from the Diabetic Foot Unit at Wolfson Medical Center.
        Harefuah. 2008; 147: 197-199
        • Zandman-Goddard G.
        • Feldbrin Z.
        • Ovadia S.
        • Zubkov T.
        • Lipkin A.
        • Wainstein J.
        A multi-disciplinary approach to diabetic foot patients - an organizational model for the treatment of leg complications in diabetic patients.
        Harefuah. 2011; 150: 593-595
        • American Diabetes Association
        Standards of medical care in diabetes–2010.
        Diabetes Care. 2010; 33: S11-S61
        • Umpierrez G.E.
        • Hellman R.
        • Korytkowski M.T.
        • et al.
        Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2012; 97: 16-38
        • Knecht L.A.D.
        • Gauthier S.M.
        • Castro J.C.
        • et al.
        Diabetes care in the hospital: is there clinical inertia?.
        J Hosp Med. 2006; 1: 151-160
        • Boord J.B.
        • Greevy R.A.
        • Braithwaite S.S.
        • et al.
        Evaluation fo hospital glycemic control at US academic medical centers.
        J Hosp Med. 2009; 4: 35-44