Levels of serum uric acid at admission for hypoglycaemia predict 1-year mortality

Distinct Prognostic Role of Serum Uric Acid Levels for Predicting All-Cause Mortality Among Chinese Adults Aged 45~75 Years With and Without Diabetes

Introduction

The current study sought to explore the effect of baseline serum uric acid (SUA) on the risk of all-cause mortality among Chinese adults aged 45~75 years and to determine its interaction relationship with diabetes.

Methods

The study was designed as a community-based cohort of 4467 adults aged between 45~75 years included in a 6-years follow-up period from 2009 to 2015 years by the China Health and Nutrition Survey (CHNS). Baseline SUA levels were grouped into quartiles and its association on all-cause mortality was explored using multivariate Cox proportional hazards models. Stratified analyses were performed to explore the associations of SUA quartiles with all-cause mortality among diabetic and non-diabetic individuals.

Results

A total of 141 deaths (5.3 per 1000 person-years) were recorded During a follow-up of 26431 person-years. Out of the 141 deaths, 28 deaths (10.1 per 1000 person-years) were reported in the diabetic groups and 113 deaths (4.8 per 1000 person-years) were recorded in the non-diabetic group. An increased risk of all-cause mortality was observed for participants in the first and fourth quartiles compared with the second SUA quartile, (Q1 SUA: aHR=2.1, 95% CI 1.1~4.1; Q4 SUA: aHR=2.1, 95% CI 1.1~4.0). Stratification of participants by diabetes status showed a U-shaped association for non-diabetic individuals. Whereas, declined eGFR, rather than SUA, was an independent risk factor for all-cause mortality in diabetic individuals (aHR=0.7, 95% CI 0.6~1.0).

Conclusion

Our study proved that the prognostic role of SUA for predicting all-cause death might be regulated by diabetes. Both low and high SUA levels were associated with increased mortality, supporting a U-shaped association only in non-diabetic individuals. Whereas, renal dysfunction rather than SUA was an independent risk factor for all-cause mortality. Further studies should be conducted to determine the SUA levels at which intervention should be conducted and explore target follow-up strategies to prevent progression leading to poor prognosis.

Association of severe hypoglycemia with all-cause mortality and complication risks among patients with type 2 diabetes mellitus in China

AIMS

To investigate the association of severe hypoglycemia (SH) with all-cause mortality and complication risks among Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

Cohort study and nested case-control studies were conducted based on medical insurance database 2008-2015. The incidence of outcomes or the exposure of previous SH was compared among matched patients, respectively. The association between SH and outcomes was investigated and validated by different models.

RESULTS

Among cohort study participants (mean age of 59.0 ± 11.2 years), SH was associated with higher risk of all-cause mortality (HR = 1.80, P < 0.001) and transient ischemic attacks (TIA, HR = 1.51, P < 0.001), while no association was observed between SH and complications including myocardial infarction (MI), angina, arrhythmia and stroke. Similarly, SH was associated with about doubled all-cause mortality (OR = 1.76, P < 0.001) and TIA (OR = 2.00, P < 0.001), but not associated with risk of MI or stroke in nested case-control studies.

CONCLUSIONS

In Chinese patients with T2DM, SH is associated with increased risk of all-cause mortality and TIA, but no significant differences were found regard to the other examined complication risks, which need to be further explored in future studies.

Association of severe hypoglycemia with mortality for people with diabetes mellitus during a 20-year follow-up in Denmark: a cohort study

AIMS

Severe hypoglycemia has a significant deteriorating effect on quality of life of the individual and has been associated with increased mortality. The aim of this study was to investigate the mortality among people with type 1 and type 2 diabetes suffering from severe hypoglycemia in Denmark in the last two decades.

METHODS

People diagnosed with type 1 (n = 44,033) and type 2 diabetes (n = 333,581) were extracted from the complete population of Denmark from 1996 to 2017 via ICD-10 diabetes codes and ATC diabetes medication codes. People suffering from severe hypoglycemia (type 1 diabetes n = 8808, type 2 diabetes n = 5605) as identified from ICD-10 codes were then matched 1:1 by year of birth, gender and year of diabetes diagnosis with those without severe hypoglycemia. Cox proportional hazards models were constructed to analyze the effect of severe hypoglycemia on mortality.

RESULTS

For both people with type 1 (HR 1.11, CI 95% 1.06 to 1.17) and type 2 diabetes (HR 1.77, CI 95% 1.67 to 1.87) suffering from hypoglycemia, an increased mortality risk was observed, compared to people without severe hypoglycemia. An investigation of the death causes did not indicate an association between the severe hypoglycemic episodes and death.

CONCLUSION

In this study, severe hypoglycemic episodes increased the mortality risk for people with type 1 and type 2 diabetes. The risk was higher among people with type 2 diabetes. Whether severe hypoglycemia is a symptom of other underlying illnesses increasing mortality risk or a risk factor itself needs further investigation.

Hypoglycaemic episodes increase the risk of ventricular arrhythmia and sudden cardiac arrest in patients with type 2 diabetes-A nationwide cohort study

BACKGROUND

The impact of hypoglycaemic episode (HE) on the risk of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA) remains unclear. We hypothesized that HE increases the risk of both VA and SCA and that glucose-lowering agents causing HE also increase the risk of VA/SCA in patients with type 2 diabetes (T2D).

METHODS

Patients aged 20 years or older with newly diagnosed T2D were identified using the Taiwan National Health Insurance Database. HE was defined as the presentation of hypoglycaemic coma or specified/unspecified hypoglycaemia. The control group consisted of T2D patients without HE. The primary outcome was the occurrence of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. A multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.

RESULTS

A total of 54 303 patients were screened, with 1037 patients with HE assigned to the HE group and 4148 frequency-matched patients without HE constituting the control group. During a mean follow-up period of 3.3 ± 2.5 years, 29 VA/SCA events occurred. Compared with the control group, HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, P = .04). Patients who had used insulin for glycaemic control showed an increased risk of VA/SCA compared with patients who did not receive insulin (adjusted HR: 3.05, P = .01).

CONCLUSIONS

The HEs in patients with T2D increased the risk of VA/SCA, compared with those who did not experience HEs. Use of insulin also independently increased the risk of VA/SCA.

Predisposing factors for hypoglycaemia in the emergency department

OBJECTIVE

Hypoglycaemia is a common complication of diabetes mellitus. Previous studies suggest that hypoglycaemic episodes may occur with other comorbidities, influencing the outcome of recovery. Recognising the predisposing factors for hypoglycaemic episodes in the emergency department is important. Therefore, we investigated the characteristics of and predisposing factors for hypoglycaemia in the emergency department.

METHODS

Data from 186 patients were retrospectively collected from a medical centre in northern Taiwan. We divided the patients into the advanced-age group (132 patients) and the younger group (54 patients). Associated data collected for statistical analysis included vital signs on arrival, first measured blood glucose level, laboratory results, related comorbidities, length of hospital stay, and survival to discharge.

RESULTS

Hypoglycaemia was more frequently observed in women in the advanced-age group than in the younger group. Tachycardia and elevated systolic blood pressure were less predominant in the advanced-age group than younger group. More patients in the advanced-age group had concurrent infection, and more patients in the younger group had liver dysfunction, elevated liver enzymes, liver cirrhosis, and concurrent stroke.

CONCLUSIONS

Closer attention should be paid to the possibility of infection in patients of advanced age. Liver disease and stroke need to be ruled out in younger patients.

Predisposing factors for hypoglycaemia in the emergency department

OBJECTIVE

Hypoglycaemia is a common complication of diabetes mellitus. Previous studies suggest that hypoglycaemic episodes may occur with other comorbidities, influencing the outcome of recovery. Recognising the predisposing factors for hypoglycaemic episodes in the emergency department is important. Therefore, we investigated the characteristics of and predisposing factors for hypoglycaemia in the emergency department.

METHODS

Data from 186 patients were retrospectively collected from a medical centre in northern Taiwan. We divided the patients into the advanced-age group (132 patients) and the younger group (54 patients). Associated data collected for statistical analysis included vital signs on arrival, first measured blood glucose level, laboratory results, related comorbidities, length of hospital stay, and survival to discharge.

RESULTS

Hypoglycaemia was more frequently observed in women in the advanced-age group than in the younger group. Tachycardia and elevated systolic blood pressure were less predominant in the advanced-age group than younger group. More patients in the advanced-age group had concurrent infection, and more patients in the younger group had liver dysfunction, elevated liver enzymes, liver cirrhosis, and concurrent stroke.

CONCLUSIONS

Closer attention should be paid to the possibility of infection in patients of advanced age. Liver disease and stroke need to be ruled out in younger patients.