Subsequent mortality after hyperglycemic crisis episode in the non-elderly

a national population-based cohort study

Yuan Kao, Chien Chin Hsu, Shih Feng Weng, Hung Jung Lin, Jhi Joung Wang, Shih Bin Su, Chien Cheng Huang, How-Ran Guo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Hyperglycemic crisis episodes (HCEs)—diabetic ketoacidosis and the hyperosmolar hyperglycemic state—are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1 %) patients with HCE and 725 (4.71 %) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40–64 years) [IRR 3.29; 95 % confidence interval (CI) 2.98–3.64] and young adult (18–39 years) (IRR 3.91; 95 % CI 3.28–4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95 % CI 0.21–7.64). The mortality risk was highest in the first month (IRR 54.43; 95 % CI 27.98–105.89), and still high after 8 years (IRR 2.05; 95 % CI 1.55–2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.

Original languageEnglish
Pages (from-to)72-82
Number of pages11
JournalEndocrine
Volume51
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

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Cohort Studies
Mortality
Population
Confidence Intervals
Incidence
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar Nonketotic Coma
Comorbidity
National Health Programs
Diabetes Complications
Chronic Obstructive Pulmonary Disease
Liver Diseases
Young Adult
Heart Diseases
Heart Failure
Stroke
Databases
Pediatrics
Research
Neoplasms

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Kao, Yuan ; Hsu, Chien Chin ; Weng, Shih Feng ; Lin, Hung Jung ; Wang, Jhi Joung ; Su, Shih Bin ; Huang, Chien Cheng ; Guo, How-Ran. / Subsequent mortality after hyperglycemic crisis episode in the non-elderly : a national population-based cohort study. In: Endocrine. 2016 ; Vol. 51, No. 1. pp. 72-82.
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Subsequent mortality after hyperglycemic crisis episode in the non-elderly : a national population-based cohort study. / Kao, Yuan; Hsu, Chien Chin; Weng, Shih Feng; Lin, Hung Jung; Wang, Jhi Joung; Su, Shih Bin; Huang, Chien Cheng; Guo, How-Ran.

In: Endocrine, Vol. 51, No. 1, 01.01.2016, p. 72-82.

Research output: Contribution to journalArticle

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T1 - Subsequent mortality after hyperglycemic crisis episode in the non-elderly

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AU - Kao, Yuan

AU - Hsu, Chien Chin

AU - Weng, Shih Feng

AU - Lin, Hung Jung

AU - Wang, Jhi Joung

AU - Su, Shih Bin

AU - Huang, Chien Cheng

AU - Guo, How-Ran

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N2 - Hyperglycemic crisis episodes (HCEs)—diabetic ketoacidosis and the hyperosmolar hyperglycemic state—are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1 %) patients with HCE and 725 (4.71 %) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40–64 years) [IRR 3.29; 95 % confidence interval (CI) 2.98–3.64] and young adult (18–39 years) (IRR 3.91; 95 % CI 3.28–4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95 % CI 0.21–7.64). The mortality risk was highest in the first month (IRR 54.43; 95 % CI 27.98–105.89), and still high after 8 years (IRR 2.05; 95 % CI 1.55–2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.

AB - Hyperglycemic crisis episodes (HCEs)—diabetic ketoacidosis and the hyperosmolar hyperglycemic state—are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1 %) patients with HCE and 725 (4.71 %) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40–64 years) [IRR 3.29; 95 % confidence interval (CI) 2.98–3.64] and young adult (18–39 years) (IRR 3.91; 95 % CI 3.28–4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95 % CI 0.21–7.64). The mortality risk was highest in the first month (IRR 54.43; 95 % CI 27.98–105.89), and still high after 8 years (IRR 2.05; 95 % CI 1.55–2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.

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