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Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease.

Tsujimoto T, Yamamoto-Honda R, Kajio H, Kishimoto M, Noto H, Hachiya R, Kimura A, Kakei M, Noda M - Acta Diabetol (2014)

Bottom Line: The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)].In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004).Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan.

ABSTRACT

Aim: The present study examined the clinical conditions and predictors of death in non-diabetic patients with pre-hospital severe hypoglycemia.

Materials and methods: From January 2006 to March 2012, we retrospectively reviewed the medical records to assess the patients with pre-hospital severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms requiring the medical assistance of another person. The patients were followed up for 90 days after the severe hypoglycemia episode.

Results: A total of 59,602 consecutive cases that visited the emergency room were screened, and 530 patients with severe hypoglycemia were included in the subsequent analysis. The mean blood glucose levels in the non-diabetes (non-DM, n = 163) and diabetes (DM, n = 367) groups were 42.9 and 33.7 mg/dL, respectively. The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)]. Mortalities within 90 days after severe hypoglycemia were significantly higher in the non-DM group than in the DM group [20.3 vs. 1.6 % (P < 0.001)]. In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004).

Conclusions: Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.

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Related in: MedlinePlus

Flowchart of study participants. Non-DM non-diabetes, DM diabetes mellitus
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Fig1: Flowchart of study participants. Non-DM non-diabetes, DM diabetes mellitus

Mentions: A total of 59,602 consecutive cases that visited the emergency room by ambulance were screened, and 530 patients with severe hypoglycemia met the criteria for inclusion in this study (Fig. 1). The clinical characteristics of this study population upon arrival are presented in Table 1. In the DM group, the numbers (%) of type 1 diabetes, type 2 diabetes, and other diabetes were 63 (17.2 %), 293 (79.8 %), and 11 (3.0 %), respectively. In the non-DM (n = 163) and DM (n = 367) groups, the mean ± SD blood glucose levels were 42.9 ± 23.2 and 33.7 ± 15.7 mg/dL, respectively (P < 0.001). Patient age and sex were not significantly different between the non-DM and DM groups. The prevalence of known cardiovascular disease and preexisting hypertension in the DM group was significantly higher, and the estimated GFR in the DM group was significantly lower than that in the non-DM group. The patients in the non-DM group had a broad range of causes of severe hypoglycemia, with the major ones being malnutrition, alcohol abuse, post-gastrectomy, and infection. Meanwhile, almost all the patients of severe hypoglycemia in the DM group were caused by glucose-lowering medications, and the causes of severe hypoglycemia were completely different between the non-DM and DM groups.Fig. 1


Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease.

Tsujimoto T, Yamamoto-Honda R, Kajio H, Kishimoto M, Noto H, Hachiya R, Kimura A, Kakei M, Noda M - Acta Diabetol (2014)

Flowchart of study participants. Non-DM non-diabetes, DM diabetes mellitus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374114&req=5

Fig1: Flowchart of study participants. Non-DM non-diabetes, DM diabetes mellitus
Mentions: A total of 59,602 consecutive cases that visited the emergency room by ambulance were screened, and 530 patients with severe hypoglycemia met the criteria for inclusion in this study (Fig. 1). The clinical characteristics of this study population upon arrival are presented in Table 1. In the DM group, the numbers (%) of type 1 diabetes, type 2 diabetes, and other diabetes were 63 (17.2 %), 293 (79.8 %), and 11 (3.0 %), respectively. In the non-DM (n = 163) and DM (n = 367) groups, the mean ± SD blood glucose levels were 42.9 ± 23.2 and 33.7 ± 15.7 mg/dL, respectively (P < 0.001). Patient age and sex were not significantly different between the non-DM and DM groups. The prevalence of known cardiovascular disease and preexisting hypertension in the DM group was significantly higher, and the estimated GFR in the DM group was significantly lower than that in the non-DM group. The patients in the non-DM group had a broad range of causes of severe hypoglycemia, with the major ones being malnutrition, alcohol abuse, post-gastrectomy, and infection. Meanwhile, almost all the patients of severe hypoglycemia in the DM group were caused by glucose-lowering medications, and the causes of severe hypoglycemia were completely different between the non-DM and DM groups.Fig. 1

Bottom Line: The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)].In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004).Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan.

ABSTRACT

Aim: The present study examined the clinical conditions and predictors of death in non-diabetic patients with pre-hospital severe hypoglycemia.

Materials and methods: From January 2006 to March 2012, we retrospectively reviewed the medical records to assess the patients with pre-hospital severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms requiring the medical assistance of another person. The patients were followed up for 90 days after the severe hypoglycemia episode.

Results: A total of 59,602 consecutive cases that visited the emergency room were screened, and 530 patients with severe hypoglycemia were included in the subsequent analysis. The mean blood glucose levels in the non-diabetes (non-DM, n = 163) and diabetes (DM, n = 367) groups were 42.9 and 33.7 mg/dL, respectively. The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)]. Mortalities within 90 days after severe hypoglycemia were significantly higher in the non-DM group than in the DM group [20.3 vs. 1.6 % (P < 0.001)]. In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004).

Conclusions: Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.

Show MeSH
Related in: MedlinePlus