Impact of diabetes on inpatient mortality and length of stay for elderly patients presenting with fracture of the proximal femur

Nirantharakumar, Krish; Toulis, Konstantinos; Wijesinghe, Haren; Mastan, M; Srikantharajah, Mukunthan; Bhatta, Surendra; Marshall, Tom; Coleman, Jamie J.

doi:10.1016/j.jdiacomp.2012.11.010

Cited by 14 publications

(17 citation statements)

References 16 publications

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“…Both, hypo‐ and hyperglycaemia are associated with poor clinical outcomes including prolonged hospitalization, complications and death . In general wards, current guidelines recommend a target glucose range of 7.8 to 10.0 mmol/L; for selected patients, more stringent targets (6.1‐7.8 mmol/mol) can be applied if safely achieved without relevant hypoglycaemia .…”

Section: Introductionmentioning

confidence: 99%

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

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Aims To investigate efficacy, safety and usability of the GlucoTab system for glycaemic management using insulin glargine U300 in non‐critically ill hospitalized patients with type 2 diabetes (T2D). Materials and Methods In this open, non‐controlled single‐arm pilot study, glycaemic control at the general ward of a tertiary care hospital was guided by a mobile decision support system (GlucoTab) for basal‐bolus insulin dosing using the novel basal insulin analogue insulin glargine U300 for the first time. Glycaemic control was surveilled with capillary glucose measurements and continuous glucose monitoring (CGM). The primary endpoint was efficacy of glycaemic management, defined as the percentage of blood glucose measurements within the target range of 3.9 to 7.8 mmol/L. Results A total of 30 patients with T2D (12 female; age, 67 ± 11 years; HbA1c, 70 ± 26 mmol/mol; BMI, 31.8 ± 5.6 kg/m 2 ; length of study, 8.5 ± 4.5 days) were included. In total, 894 capillary glucose values and 49 846 data points of CGM were available, of which 56.1% of all measured capillary glucose values and 54.3% of CGM values were within the target area (3.9‐7.8 mmol/L). Overall capillary mean glucose was 8.5 ± 1.2 and 8.4 ± 1.2 mmol/L assessed by CGM. Time within glucose target improved continuously during the course of treatment, while time within hypoglycaemia (<3.9 mmol/L) decreased substantially. The GlucoTab‐suggested total daily dose was accepted by staff in 97.3% of situations. Conclusions Treatment with GlucoTab using insulin glargine U300 in hospitalized patients with T2D is effective and safe.

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Section: Introductionmentioning

confidence: 99%

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Aberer

Lichtenegger

Smajic

et al. 2018

Diabetes Obesity Metabolism

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“…Most of studies that deal with mortality and diabetes are longitudinal studies [20][21][22][23][24]. There only a few studies that explore in-hospital mortality associated with diabetes and these are disease speci c [25][26][27]. Two of the studies show not effect on inpatient mortality [25,27].…”

Section: Discussionmentioning

confidence: 99%

“…There only a few studies that explore in-hospital mortality associated with diabetes and these are disease speci c [25][26][27]. Two of the studies show not effect on inpatient mortality [25,27]. The third showed an odds ratio of 1.31 (1.04-1.65) for mortality in diabetics with foot disease [26].…”

Section: Discussionmentioning

confidence: 99%

Mortality is Not Increased with Diabetes in Hospitalized Very Elderly A multi-site Review.

Smerdely¹

2020

Preprint

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Objective: As there is little data about hospital outcomes in people with diabetes aged beyond 75, this study aimed to explore the association of diabetes with hospital outcome of patients aged greater than 65 years.Design: A retrospective review was conducted of all presentation of patients age 65 years or more admitted to 3 Sydney teaching hospitals over a 6 year period (2012-2018) exploring primarily the outcomes of in hospital mortality and secondarily the outcomes of length of stay, the development of hospital acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and co-morbidities was determined from ICD10 coding within the hospital’s electronic medical record. Logistic and negative binomial regression models were used to assess association of diabetes with outcome. Results: Of the 139130 separations included, the mean age was 80 years (range 65 to 107 years); 51% were female, 49% had comorbidities. 26.1% had a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE(0.02), p<0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While diabetics overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p<0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital acquired adverse events (OR: 1.09 SE (0.02), p<0.001) and but not 28 day readmission (OR: 0.88 SE(0.18), p=0.523).Conclusion: Diabetes has not been shown to have a negative impact on mortality or length of stay in the hospitalized very elderly from data derived from hospital administrative records.

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“…Patients with type 2 diabetes mellitus (T2DM) are at increased risk of osteoporotic fractures . Notably, fragility fractures in the context of T2DM‐related osteoporosis are associated with increased mortality; therefore, any factor that might, even incrementally, affect this risk should be of concern in the management of T2DM.…”

Section: Introductionmentioning

confidence: 99%

Initiation of dapagliflozin and treatment‐emergent fractures

Toulis

Bilezikian

Thomas

et al. 2018

Diabetes Obesity Metabolism

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An increase in fracture risk has been reported in patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin, possibly mediated by effects induced by all members of the sodium-glucose co-transporter-2 (SGLT2) inhibitor class. It is unclear whether initiation of dapagliflozin is followed by an increase in the risk of fracture; therefore, we performed a population-based, open cohort study (from January 2013 to January 2016) using The Health Improvement Network (THIN). A total of 22 618 people with T2DM (4548 exposed to dapagliflozin and 18 070 receiving standard antidiabetic treatment, matched for age, sex, body mass index and diabetes duration) with no history of fractures at baseline were included. The primary outcome was the occurrence of any fragility fracture (hip, spine, wrist) during the observation period. Risk of any fracture served as a secondary outcome. Adjusted hazard rate ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression. A total of 289 fractures (132 fragility fractures) were recorded. No difference in the risk of fragility fracture was detected between participants prescribed dapagliflozin and matched control participants (crude HR 0.90, 95% CI 0.59-1.39, P = .645; adjusted HR 0.87, 95% CI 0.56-1.35, P = .531). Similarly, no difference in the risk of any fracture was detected (adjusted HR 0.89, 95% CI 0.66-1.20; P = .427). Sensitivity analyses limited to the subset of the population at high risk of fracture produced similar results; thus, there was no evidence to suggest an increase in the risk of treatment-emergent fractures in patients with T2DM who initiated treatment with dapagliflozin.

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Impact of diabetes on inpatient mortality and length of stay for elderly patients presenting with fracture of the proximal femur

Cited by 14 publications

References 16 publications

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

GlucoTab‐guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes

Mortality is Not Increased with Diabetes in Hospitalized Very Elderly A multi-site Review.

Initiation of dapagliflozin and treatment‐emergent fractures

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