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Stress hyperglycaemia in hospitalised patients and their 3-year risk of diabetes: a Scottish retrospective cohort study.
PLoS Med. 2014 Aug; 11(8):e1001708.PM

Abstract

BACKGROUND

Hyperglycaemia during hospital admission is common in patients who are not known to have diabetes and is associated with adverse outcomes. The risk of subsequently developing type 2 diabetes, however, is not known. We linked a national database of hospital admissions with a national register of diabetes to describe the association between admission glucose and the risk of subsequently developing type 2 diabetes.

METHODS AND FINDINGS

In a retrospective cohort study, patients aged 30 years or older with an emergency admission to hospital between 2004 and 2008 were included. Prevalent and incident diabetes were identified through the Scottish Care Information (SCI)-Diabetes Collaboration national registry. Patients diagnosed prior to or up to 30 days after hospitalisation were defined as prevalent diabetes and were excluded. The predicted risk of developing incident type 2 diabetes during the 3 years following hospital discharge by admission glucose, age, and sex was obtained from logistic regression models. We performed separate analyses for patients aged 40 and older, and patients aged 30 to 39 years. Glucose was measured in 86,634 (71.0%) patients aged 40 and older on admission to hospital. The 3-year risk of developing type 2 diabetes was 2.3% (1,952/86,512) overall, was <1% for a glucose ≤ 5 mmol/l, and increased to approximately 15% at 15 mmol/l. The risks at 7 mmol/l and 11.1 mmol/l were 2.6% (95% CI 2.5-2.7) and 9.9% (95% CI 9.2-10.6), respectively, with one in four (21,828/86,512) and one in 40 (1,798/86,512) patients having glucose levels above each of these cut-points. For patients aged 30-39, the risks at 7 mmol/l and 11.1 mmol/l were 1.0% (95% CI 0.8-1.3) and 7.8% (95% CI 5.7-10.7), respectively, with one in eight (1,588/11,875) and one in 100 (120/11,875) having glucose levels above each of these cut-points. The risk of diabetes was also associated with age, sex, and socio-economic deprivation, but not with specialty (medical versus surgical), raised white cell count, or co-morbidity. Similar results were obtained for pre-specified sub-groups admitted with myocardial infarction, chronic obstructive pulmonary disease, and stroke. There were 25,193 deaths (85.8 per 1,000 person-years) over 297,122 person-years, of which 2,406 (8.1 per 1,000 person-years) were attributed to vascular disease. Patients with glucose levels of 11.1 to 15 mmol/l and >15 mmol/l had higher mortality than patients with a glucose of <6.1 mmol/l (hazard ratio 1.54; 95% CI 1.42-1.68 and 2.50; 95% CI 2.14-2.95, respectively) in models adjusting for age and sex. Limitations of our study include that we did not have data on ethnicity or body mass index, which may have improved prediction and the results have not been validated in non-white populations or populations outside of Scotland.

CONCLUSION

Plasma glucose measured during an emergency hospital admission predicts subsequent risk of developing type 2 diabetes. Mortality was also 1.5-fold higher in patients with elevated glucose levels. Our findings can be used to inform patients of their long-term risk of type 2 diabetes, and to target lifestyle advice to those patients at highest risk. Please see later in the article for the Editors' Summary.

Authors+Show Affiliations

Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.University of Edinburgh/BHF Centre for Cardiovascular Health Science, University of Edinburgh, Edinburgh, United Kingdom.Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.University of Edinburgh/BHF Centre for Cardiovascular Health Science, University of Edinburgh, Edinburgh, United Kingdom.Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.Metabolic Unit and Acute Medicine Departments, NHS Lothian, Edinburgh, United Kingdom.Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25136809

Citation

McAllister, David A., et al. "Stress Hyperglycaemia in Hospitalised Patients and Their 3-year Risk of Diabetes: a Scottish Retrospective Cohort Study." PLoS Medicine, vol. 11, no. 8, 2014, pp. e1001708.
McAllister DA, Hughes KA, Lone N, et al. Stress hyperglycaemia in hospitalised patients and their 3-year risk of diabetes: a Scottish retrospective cohort study. PLoS Med. 2014;11(8):e1001708.
McAllister, D. A., Hughes, K. A., Lone, N., Mills, N. L., Sattar, N., McKnight, J., & Wild, S. H. (2014). Stress hyperglycaemia in hospitalised patients and their 3-year risk of diabetes: a Scottish retrospective cohort study. PLoS Medicine, 11(8), e1001708. https://doi.org/10.1371/journal.pmed.1001708
McAllister DA, et al. Stress Hyperglycaemia in Hospitalised Patients and Their 3-year Risk of Diabetes: a Scottish Retrospective Cohort Study. PLoS Med. 2014;11(8):e1001708. PubMed PMID: 25136809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stress hyperglycaemia in hospitalised patients and their 3-year risk of diabetes: a Scottish retrospective cohort study. AU - McAllister,David A, AU - Hughes,Katherine A, AU - Lone,Nazir, AU - Mills,Nicholas L, AU - Sattar,Naveed, AU - McKnight,John, AU - Wild,Sarah H, Y1 - 2014/08/19/ PY - 2014/03/04/received PY - 2014/07/17/accepted PY - 2014/8/20/entrez PY - 2014/8/20/pubmed PY - 2015/10/16/medline SP - e1001708 EP - e1001708 JF - PLoS medicine JO - PLoS Med. VL - 11 IS - 8 N2 - BACKGROUND: Hyperglycaemia during hospital admission is common in patients who are not known to have diabetes and is associated with adverse outcomes. The risk of subsequently developing type 2 diabetes, however, is not known. We linked a national database of hospital admissions with a national register of diabetes to describe the association between admission glucose and the risk of subsequently developing type 2 diabetes. METHODS AND FINDINGS: In a retrospective cohort study, patients aged 30 years or older with an emergency admission to hospital between 2004 and 2008 were included. Prevalent and incident diabetes were identified through the Scottish Care Information (SCI)-Diabetes Collaboration national registry. Patients diagnosed prior to or up to 30 days after hospitalisation were defined as prevalent diabetes and were excluded. The predicted risk of developing incident type 2 diabetes during the 3 years following hospital discharge by admission glucose, age, and sex was obtained from logistic regression models. We performed separate analyses for patients aged 40 and older, and patients aged 30 to 39 years. Glucose was measured in 86,634 (71.0%) patients aged 40 and older on admission to hospital. The 3-year risk of developing type 2 diabetes was 2.3% (1,952/86,512) overall, was <1% for a glucose ≤ 5 mmol/l, and increased to approximately 15% at 15 mmol/l. The risks at 7 mmol/l and 11.1 mmol/l were 2.6% (95% CI 2.5-2.7) and 9.9% (95% CI 9.2-10.6), respectively, with one in four (21,828/86,512) and one in 40 (1,798/86,512) patients having glucose levels above each of these cut-points. For patients aged 30-39, the risks at 7 mmol/l and 11.1 mmol/l were 1.0% (95% CI 0.8-1.3) and 7.8% (95% CI 5.7-10.7), respectively, with one in eight (1,588/11,875) and one in 100 (120/11,875) having glucose levels above each of these cut-points. The risk of diabetes was also associated with age, sex, and socio-economic deprivation, but not with specialty (medical versus surgical), raised white cell count, or co-morbidity. Similar results were obtained for pre-specified sub-groups admitted with myocardial infarction, chronic obstructive pulmonary disease, and stroke. There were 25,193 deaths (85.8 per 1,000 person-years) over 297,122 person-years, of which 2,406 (8.1 per 1,000 person-years) were attributed to vascular disease. Patients with glucose levels of 11.1 to 15 mmol/l and >15 mmol/l had higher mortality than patients with a glucose of <6.1 mmol/l (hazard ratio 1.54; 95% CI 1.42-1.68 and 2.50; 95% CI 2.14-2.95, respectively) in models adjusting for age and sex. Limitations of our study include that we did not have data on ethnicity or body mass index, which may have improved prediction and the results have not been validated in non-white populations or populations outside of Scotland. CONCLUSION: Plasma glucose measured during an emergency hospital admission predicts subsequent risk of developing type 2 diabetes. Mortality was also 1.5-fold higher in patients with elevated glucose levels. Our findings can be used to inform patients of their long-term risk of type 2 diabetes, and to target lifestyle advice to those patients at highest risk. Please see later in the article for the Editors' Summary. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/25136809/Stress_hyperglycaemia_in_hospitalised_patients_and_their_3_year_risk_of_diabetes:_a_Scottish_retrospective_cohort_study_ L2 - http://dx.plos.org/10.1371/journal.pmed.1001708 DB - PRIME DP - Unbound Medicine ER -