發生高血糖危症會增加糖尿病病人長期死亡率
Hyperglycemic crisis episode increases long-term mortality in the patients with
diabetes
高元 1、黃建程 1、鍾旻憲 1、許建清 1、林宏榮 1、郭浩然 2,3、蘇世斌 4
奇美醫學中心急診部 1、國立成功大學環境醫學研究所 2、國立成功大學附設醫院職
業及環境醫學部 3、奇美醫學中心職業醫學科 4
Background: Hyperglycemic crises present a disease continuum of diabetic emergency
consisting of three subgroups: diabetic ketoacidosis (DKA), hyperosmolar
hyperglycemic state (HHS), and mixed DKA/HHS. The most common precipitants are
poor compliance, infection, new-onset diabetes, pancreatitis, acute coronary syndrome,
stroke, and medications. The mortality, incidence and the cost of treating hyperglycemic
crises remains high and continues to rise despite of the medical advancement. However,
previous studies of hyperglycemic crises were all about acute episode.
Objective: We investigated long-term prognosis of patients with hyperglycemic crises
episode. This topic has not been delineated.
Methods: The database was from patients with new-onset diabetes from 2000-2002 of
Taiwan’s National Health Insurance Research Database. In this retrospective
population-based cohort study, 13487 patients with hyperglycemic crises episode and
26974 controls without hyperglycemic crises episode (1:2) were selected. Comparison of
two groups and follow-up prognosis till 2011 were done.
Results: Two thousand fifty-eight (21. 9%) patients with hyperglycemic crises episode
and 2622 (9.7%) controls died (P < 0.0001) during follow-up. Incidence rate ratios (IRR)
of death were 2.51 times higher in patients with hyperglycemic crises episode than in
controls (P < 0.0001). The risk of death was high in the first 6 months after
hyperglycemic crises episode (IRR: 9.50; 95% confidence interval CI: 8.26-10.94), 6 to
12 months after (IRR: 2.62; 95% CI: 2.18-3.15), 1-2 years after (IRR: 2.21; 95% CI:
1.90-2.56), 2-4 years after (IRR: 1.78; 95% CI: 1.59-2.00), 4-6 years after (IRR: 1.57;
95% CI: 1.37-1.80), 6-8 years after (IRR: 1.50; 95% CI: 1.27-1.76), and ≥ 8 years (IRR:
1.47; 95% CI: 1.24-1.77). After adjusting for age, gender, and selected comorbidities,
the hazard ratio of death for patients with hyperglycemic crises episode was still 2.703
times higher than for controls. Moreover, older age, male gender, renal disease, stroke,
cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease
were also independent mortality predictors.
Conclusions: Hyperglycemic crises episode significantly increases the risk for
long-term mortality in patients with diabetes. Early follow-up and secondary prevention
of death are needed for patients with hyperglycemic crises episode.