Original Data

Rev Diabet Stud, 2021, 17(2):50-56 DOI 10.1900/RDS.2021.17.50

In-Hospital Mortality and Glycemic Control in Patients with Hospital Hyperglycemia

María Paula Russo1, Santiago Nicolas Marquez Fosser2,3, Cristina María Elizondo1, Diego Hernán Giunta1, Nora Angélica Fuentes4, María Florencia Grande-Ratti1,3

1Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
2Clinical and Health Informatics Research Group, McGill University, Montréal, Québec, Canada
3Department of Health Informatics, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
4Centro de Investigaciones Clínicas, Mar del Plata, Argentina
Address correspondence to: María Florencia Grande Ratti, e-mail: maria.grande@hospitalitaliano.org.ar


BACKGROUND: Stress-induced hyperglycemia is a phenomenon that occurs typically in patients hospitalized for acute disease and resolves spontaneously after regression of the acute illness. However, it can also occur in diabetes patients, a fact that is sometimes overlooked. It is thus important to make a proper diabetes diagnosis if hospitalized patients with episodes of hyperglycemia with and without diabetes are studied. AIMS: To estimate the extent of the association between stress-induced hyperglycemia and in-hospital mortality in patients with hospital hyperglycemia (HH), and to explore potential differences between patients diagnosed with diabetes (HH-DBT) and those with stress-induced hyperglycemia (SH), but not diagnosed with diabetes. METHODS: A cohort of adults with hospital hyperglycemia admitted to a tertiary, university hospital in Buenos Aires, Argentina, was analyzed retrospectively. RESULTS: In the study, 2,955 patients were included and classified for analysis as 1,579 SH and 1,376 HH-DBT. Significant differences were observed in glycemic goal (35.53% SH versus 25.80% HH-DBT, p < 0.01), insulin use rate (26.66% SH versus 46.58% HH-DBT, p < 0.01), and severe hypoglycemia rate (1.32% SH versus 1.74% HH-DBT, p < 0.01). There were no differences in hypoglycemia rate (8.23% SH versus 10.53% HH-DBT) and hospital mortality. There was no increase in risk of mortality in the SH group adjusted for age, non-scheduled hospitalization, major surgical intervention, critical care, hypoglycemia, oncological disease, cardiovascular comorbidity, and prolonged hospitalization. CONCLUSIONS: In this study, we observed better glycemic control in patients with SH than in those with HH-DBT, and there was no difference in hospital mortality.

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Rev Diabet Stud, 2021, 17(2):68-74 DOI 10.1900/RDS.2021.17.68

Clinical Features, Biochemical Profile, and Response to Standard Treatment in Lean, Normal-Weight, and Overweight/Obese Indian Type 2 Diabetes Patients

Ahmad Faraz1, Hamid Ashraf2, Jamal Ahmad3

1Assistant Professor, Department of Physiology, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, India
2Assistant Professor, Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, India
3Former Professor of Endocrinology and Dean Faculty of Medicine, Ex-Director, Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh Diabetes and Endocrinology Super-Speciality Centre, Aligarh, India
Address correspondence to: Hamid Ashraf, e-mail: hamid2k3@gmail.com


BACKGROUND: Much evidence is available on the relationship between type 2 diabetes mellitus (T2D) and obesity, but less on T2D in lean individuals. AIM: This study was conducted in 12,069 T2D patients from northern India to find out which clinical and biochemical features are related to lean, normal weight, and overweight/obese T2D patients. METHODS: The study was conducted at two endocrine clinics in northern India as a retrospective cross-sectional study. The records of all patients who attended these clinics from January 2018 to December 2019 were screened. After screening 13,400 patients, 12,069 were labelled as type 2 diabetes mellitus according to the criteria of the American Diabetes Association, 2020, and were included in the study. The patients were subdivided into the three groups by their body mass index (BMI): lean (BMI < 18), normal weight (BMI = 18-22.9), overweight/obese (BMI ≥ 23). The study evaluated how the three subgroups responded to standard diabetes management, including antidiabetic medication and lifestyle interventions. RESULTS: Of a total of 12,069 patients 327 (2.7%) were lean, 1,841 (15.2%) of normal weight, and 9,906 (82.1%) overweight/obese. Lean patients were younger, but had more severe episodes of hyperglycemia. All three subgroups experienced significant improvements in glycemic control during follow-up; HbA1c values were significantly lowered in the overweight/obese group during follow-up compared with baseline. CONCLUSIONS: While overweight/obese patients could benefit from the improvements in glycemic control achieved by lowering HbA1c, lean and normal-weight patients had more severe and difficult-to-control hyperglycemia.

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