Russo María Paula, Grande Ratti María Florencia, Giunta Diego Hernán, Elizondo Cristina María
Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Servicio Medicina Familiar y Comunitaria, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Área Epidemiológica de Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de Nación, Argentina.
Endocrinol Diabetes Nutr (Engl Ed). 2018 Dec;65(10):571-576. doi: 10.1016/j.endinu.2018.07.005. Epub 2018 Oct 4.
The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels.
A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used.
There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001).
SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population.
本研究的目的是在出院后随访期间估计糖尿病的发病率，并确定住院患者的死亡率，这些患者在随访期间根据血糖水平被分类为患有应激性高血糖（SH）或血糖正常（NG）。
使用了一个回顾性队列，其中包括患有SH（血糖>140mg/dl且糖化血红蛋白<6.5%）或NG（所有血糖值≤140mg/dl）的非糖尿病成年人。
有3981例NG患者和884例SH患者。在观察期（中位随访1.83年）内，有255例糖尿病病例和831例死亡。NG患者每年糖尿病的累积发病率为1.59%（95%CI：1.23 - 2.06），SH患者为7.39%（95%CI：5.70 - 9.56）。SH与糖尿病显著相关（粗风险比1.33，95%CI：1.13 - 1.73，p = 0.025），即使在调整年龄和性别后（调整后风险比1.38，95%CI 1.06 - 1.78，p = 0.014）。NG患者一年的死亡率为10.07%（95%CI：9.18 - 11.05），SH患者为13.24%（95%CI：11.17 - 15.65）。将死亡视为竞争事件时，发生糖尿病的亚风险比为1.41（95%CI 1.29 - 1.53，p <0.001）。
SH是糖尿病的一个风险因素。随访期间死亡率无差异，但在该人群中死亡似乎是糖尿病发生过程中的一个竞争事件。
