Schneider Andrea L C, Kalyani Rita R, Golden Sherita, Stearns Sally C, Wruck Lisa, Yeh Hsin Chieh, Coresh Josef, Selvin Elizabeth
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Diabetes Care. 2016 May;39(5):772-9. doi: 10.2337/dc15-1335. Epub 2016 Mar 7.
To examine the magnitude and types of hospitalizations among persons with prediabetes, undiagnosed diabetes, and diagnosed diabetes.
This study included 13,522 participants in the Atherosclerosis Risk in Communities (ARIC) study (mean age 57 years, 56% female, 24% black, 18% with prediabetes, 4% with undiagnosed diabetes, 9% with diagnosed diabetes) with follow-up in 1990-2011 for hospitalizations. Participants were categorized by diabetes/HbA1c status: without diagnosed diabetes, HbA1c <5.7% (reference); prediabetes, 5.7 to <6.5%; undiagnosed diabetes, ≥6.5%; and diagnosed diabetes, <7.0 and ≥7.0%.
Demographic adjusted rates per 1,000 person-years of all-cause hospitalizations were higher with increasing diabetes/HbA1c category (Ptrend < 0.001). Persons with diagnosed diabetes and HbA1c ≥7.0% had the highest rates of hospitalization (3.1 times higher than those without a history of diagnosed diabetes, HbA1c <5.7%, and 1.5 times higher than those with diagnosed diabetes, HbA1c <7.0%, P < 0.001 for both comparisons). Persons with undiagnosed diabetes had 1.6 times higher rates of hospitalization and those with prediabetes had 1.3 times higher rates of hospitalization than those without diabetes and HbA1c <5.7% (P < 0.001 for both comparisons). Rates of hospitalization by diabetes/HbA1c category were different by race (Pinteraction = 0.011) and by sex (Pinteraction = 0.020). There were significantly excess rates of hospitalizations due to cardiovascular, endocrine, respiratory, gastrointestinal, iatrogenic/injury, neoplasm, genitourinary, neurologic, and infection causes among those with diagnosed diabetes compared with those without a history of diagnosed diabetes (all P < 0.05).
Persons with diagnosed diabetes, undiagnosed diabetes, and prediabetes are at a significantly elevated risk of hospitalization compared with those without diabetes. Substantial excess rates of hospitalizations in persons with diagnosed diabetes were for endocrine, infection, and iatrogenic/injury causes, which may be preventable with improved diabetes care.
研究糖尿病前期、未诊断糖尿病及已诊断糖尿病患者的住院率及住院类型。
本研究纳入社区动脉粥样硬化风险（ARIC）研究中的13522名参与者（平均年龄57岁，56%为女性，24%为黑人，18%为糖尿病前期患者，4%为未诊断糖尿病患者，9%为已诊断糖尿病患者），并对其1990 - 2011年期间的住院情况进行随访。参与者按糖尿病/HbA1c状态分类：无已诊断糖尿病，HbA1c<5.7%（参照组）；糖尿病前期，5.7%至<6.5%；未诊断糖尿病，≥6.5%；已诊断糖尿病，<7.0%及≥7.0%。
随着糖尿病/HbA1c类别升高，经人口统计学调整后的每1000人年全因住院率更高（Ptrend<0.001）。已诊断糖尿病且HbA1c≥7.0%的患者住院率最高（比无已诊断糖尿病病史、HbA1c<5.7%的患者高3.1倍，比已诊断糖尿病、HbA1c<7.0%的患者高1.5倍，两组比较P均<0.001）。未诊断糖尿病患者的住院率比无糖尿病且HbA1c<5.7%的患者高1.6倍，糖尿病前期患者的住院率高1.3倍（两组比较P均<0.001）。糖尿病/HbA1c类别导致的住院率在种族（P交互作用=0.011）和性别（P交互作用=0.020）方面存在差异。与无已诊断糖尿病病史的患者相比，已诊断糖尿病患者因心血管、内分泌、呼吸、胃肠道、医源性/损伤、肿瘤、泌尿生殖、神经和感染等原因导致的住院率显著更高（所有P<0.05）。
与无糖尿病患者相比,已诊断糖尿病、未诊断糖尿病及糖尿病前期患者的住院风险显著升高。已诊断糖尿病患者因内分泌、感染和医源性/损伤原因导致的住院率大幅增加，改善糖尿病护理可能预防这些情况。
