Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil

Author(s): Danielle Bruginski*, Dalton Bertolin Précoma, Ary Sabbag and Marcia Olandowski

Volume 16, Issue 2, 2020

Page: [171 - 180] Pages: 10

DOI: 10.2174/1573399815999190619141622

Price: $65

Abstract

Background: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice.

Objective: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients.

Methods: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses.

Results: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality.

Conclusion: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.

Keywords: Diabetes, geriatric diseases, glycemic variability, hospital stay, mortality rates, prognosis.

[1]
Volaco A, Cavalcanti AM, Filho RP, Précoma DB. Socioeconomic status: The missing link between obesity and diabetes mellitus? Curr Diabetes Rev 2018; 14(4): 321-6.
[http://dx.doi.org/10.2174/1573399813666170621123227] [PMID: 28637406]
[2]
Schaan BD, de Figueiredo Neto JA, Moreira LB, et al. Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country. Diabetes Res Clin Pract 2017; 127: 275-84.
[http://dx.doi.org/10.1016/j.diabres.2017.03.021] [PMID: 28412543]
[3]
International Diabetes Federation (IDF). IDF Diabetes Atlas, 8th ed. Available from.. https://idf.org/e-library/welcome.html [cited: 24th Feb 2018].
[4]
Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: Systematic review and meta-analysis with bias analysis. BMJ 2013; 347: f4533.
[http://dx.doi.org/10.1136/bmj.f4533] [PMID: 23900314]
[5]
Majumdar SR, Hemmelgarn BR, Lin M, McBrien K, Manns BJ, Tonelli M. Hypoglycemia associated with hospitalization and adverse events in older people: population-based cohort study. Diabetes Care 2013; 36(11): 3585-90.
[http://dx.doi.org/10.2337/dc13-0523] [PMID: 24089536]
[6]
Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010; 363(15): 1410-8.
[http://dx.doi.org/10.1056/NEJMoa1003795] [PMID: 20925543]
[7]
Kovatchev BP, Otto E, Cox D, Gonder-Frederick L, Clarke W. Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care 2006; 29(11): 2433-8.
[http://dx.doi.org/10.2337/dc06-1085] [PMID: 17065680]
[8]
Mendez CE, Mok KT, Ata A, Tanenberg RJ, Calles-Escandon J, Umpierrez GE. Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care 2013; 36(12): 4091-7.
[http://dx.doi.org/10.2337/dc12-2430] [PMID: 24170754]
[9]
Timmons JG, Cunningham SG, Sainsbury CA, Jones GC. Inpatient glycemic variability and long-term mortality in hospitalized patients with type 2 diabetes. J Diabetes Complications 2017; 31(2): 479-82.
[http://dx.doi.org/10.1016/j.jdiacomp.2016.06.013] [PMID: 27343028]
[10]
Kovatchev B, Cobelli C. Glucose variability: timing, risk analysis, and relationship to hypoglycemia in diabetes. Diabetes Care 2016; 39(4): 502-10.
[http://dx.doi.org/10.2337/dc15-2035] [PMID: 27208366]
[11]
Kovatchev BP, Cox DJ, Gonder-Frederick LA, Clarke W. Symmetrization of the blood glucose measurement scale and its applications. Diabetes Care 1997; 20(11): 1655-8.
[http://dx.doi.org/10.2337/diacare.20.11.1655] [PMID: 9353603]
[12]
Umpierrez GE, Hellman R, Korytkowski MT, 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(1): 16-38.
[http://dx.doi.org/10.1210/jc.2011-2098] [PMID: 22223765]
[13]
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373-83.
[http://dx.doi.org/10.1016/0021-9681(87)90171-8] [PMID: 3558716]
[14]
JUSBRASIL. Available from.. https://www.jusbrasil.com.br/busca?q=Cadastro+Nacional+de+Falecidos&c= [cited: 30th April 2017].
[15]
Barbosa SR. Associação entre fragilidade e comorbidades em idosos não-institucionalizados e seu impacto em desfechos negativos de saúde Dissertação (Mestrado). Juiz de Fora: Faculdade de Medicina da Universidade Federal de Juiz de Fora 2015.. https://repositorio.ufjf.br/jspui/bitstream/ufjf/429/1/sergioribeirobarbosa.pdf [cited: 30th Mar 2017]
[16]
Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: A retrospective cohort study. Lancet 2010; 375(9713): 481-9.
[http://dx.doi.org/10.1016/S0140-6736(09)61969-3] [PMID: 20110121]
[17]
Deedwania P, Kosiborod M, Barrett E, et al. Hyperglycemia and acute coronary syndrome: A scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2008; 117(12): 1610-9.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.188629] [PMID: 18299505]
[18]
Svensson AM, McGuire DK, Abrahamsson P, Dellborg M. Association between hyper and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J 2005; 26(13): 1255-61.
[http://dx.doi.org/10.1093/eurheartj/ehi230] [PMID: 15821004]
[19]
Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 2008; 117(8): 1018-27.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.740498] [PMID: 18268145]
[20]
Skyler JS, Bergenstal R, Bonow RO, et al. American Diabetes Association; American College of Cardiology Foundation; American Heart Association. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation 2009; 119(2): 351-7.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.191305] [PMID: 19095622]
[21]
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2017; 40: Suppl 1. Available from.. http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf [cited 5th Mar 2018]
[22]
Bloomfield HE, Greer N, Newman D, et al. Predictors and consequences of severe hypoglycemia in adults with diabetes - A systematic review of the evidence. Washington, DC: Department of Veterans Affairs 2012.http://www.ncbi.nlm.nih.gov/books/NBK114893/ [cited 24th Feb 2018
[23]
Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care 2015; 38(2): 316-22.
[http://dx.doi.org/10.2337/dc14-0920] [PMID: 25492401]
[24]
Finfer S, Chittock D, Li Y, et al. NICE-SUGAR study investigators for the Australian and New Zealand intensive care society clinical trials group and the canadian critical care trials group. Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: Long-term follow-up of a subgroup of patients from the NICE-SUGAR study. Intensive Care Med 2015; 41(6): 1037-47.
[http://dx.doi.org/10.1007/s00134-015-3757-6] [PMID: 26088909]
[25]
Lipska KJ, Venkitachalam L, Gosch K, et al. Glucose variability and mortality in patients hospitalized with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2012; 5(4): 550-7.
[http://dx.doi.org/10.1161/CIRCOUTCOMES.111.963298] [PMID: 22693348]
[26]
Hermanides J, Vriesendorp TM, Bosman RJ, Zandstra DF, Hoekstra JB, Devries JH. Glucose variability is associated with intensive care unit mortality. Crit Care Med 2010; 38(3): 838-42.
[http://dx.doi.org/10.1097/CCM.0b013e3181cc4be9] [PMID: 20035218]
[27]
Kiser TH, Allen RR, Valuck RJ, Moss M, Vandivier RW. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189(9): 1052-64.
[http://dx.doi.org/10.1164/rccm.201401-0058OC] [PMID: 24617842]
[28]
Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet 2003; 362(9398): 1828-38.
[http://dx.doi.org/10.1016/S0140-6736(03)14904-5] [PMID: 14654323]
[29]
Gorst C, Kwok CS, Aslam S, et al. Long-term glycemic variability and risk of adverse outcomes: A systematic review and meta-analysis. Diabetes Care 2015; 38(12): 2354-69.
[http://dx.doi.org/10.2337/dc15-1188] [PMID: 26604281]
[30]
Kosiborod M, Inzucchi SE, Goyal A, et al. Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA 2009; 301(15): 1556-64.
[http://dx.doi.org/10.1001/jama.2009.496] [PMID: 19366775]
[31]
Hirsch IB. Sliding scale insulin--time to stop sliding. JAMA 2009; 301(2): 213-4.
[http://dx.doi.org/10.1001/jama.2008.943] [PMID: 19141770]
[32]
Umpierrez GE, Dungan K. Update on inpatient diabetes management: call for action. Diabetes Technol Ther 2015; 17(4): 225-8.
[http://dx.doi.org/10.1089/dia.2014.0283] [PMID: 25781234]
[33]
Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006; 105(2): 244-52.
[http://dx.doi.org/10.1097/00000542-200608000-00006] [PMID: 16871057]
[34]
American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41(Suppl. 1): S55-64.
[http://dx.doi.org/10.2337/dc18-S006] [PMID: 29222377]
[35]
International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: A joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2017; 40(1): 155-7.
[http://dx.doi.org/10.2337/dc16-2215] [PMID: 27872155]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy