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Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study

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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.

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Acknowledgments

This study was supported by grants CMFHR10384 from the Chi-Mei Medical Center. This study is based in part on data from the Taiwan National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare, and managed by National Health Research Institutes (Registered number NHIRD-100-057, NHIRD-102-024). The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare or National Health Research Institutes. We thank Bill Franke for his invaluable advice and editorial assistance.

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    Authors and Affiliations

    1. Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan

      Yuan Kao, Chien-Chin Hsu, Hung-Jung Lin & Chien-Cheng Huang

    2. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Chien-Chin Hsu & Hung-Jung Lin

    3. Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan

      Shih-Feng Weng & Jhi-Joung Wang

    4. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan

      Hung-Jung Lin

    5. Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan

      Shih-Bin Su & Chien-Cheng Huang

    6. Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Shih-Bin Su

    7. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan

      Chien-Cheng Huang & How-Ran Guo

    8. Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Chien-Cheng Huang

    9. Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

      Chien-Cheng Huang

    10. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

      How-Ran Guo

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    1. Yuan Kao
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    Yuan Kao and Chien-Chin Hsu have contributed equally to this work as first authors.

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    Kao, Y., Hsu, CC., Weng, SF. et al. Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study. Endocrine 51, 72–82 (2016). https://doi.org/10.1007/s12020-015-0669-8

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