Type 2 diabetes and 1-year mortality in intensive care unit patients
Article first published online: 14 DEC 2012
© 2012 The Authors. European Journal of Clinical Investigation © 2012 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 43, Issue 3, pages 238–247, March 2013
How to Cite
Eur J Clin Invest 2013; 43 (3): 238–247
- Issue published online: 14 FEB 2013
- Article first published online: 14 DEC 2012
- Accepted manuscript online: 27 NOV 2012 05:27PM EST
- Manuscript Accepted: 24 NOV 2012
- Manuscript Received: 27 SEP 2012
- Cohort study;
- diabetes mellitus type 2;
- heart disease;
- intensive care;
- kidney disease;
Data on the prognostic impact of diabetes and diabetic complications in intensive care unit (ICU) patients are limited and inconsistent. We, therefore, examined mortality in ICU patients with type 2 diabetes with and without pre-existing heart and kidney diseases compared with nondiabetic patients.
We conducted this population-based cohort study in Northern Denmark during 2005–2011. We included all ICU patients aged 40 years or older from the 17 ICUs in the area and identified type 2 diabetes by either a filled prescription for an antidiabetic drug, a previous diagnosis of diabetes, or an elevated glycosylated haemoglobin level. Diabetic patients were disaggregated according to pre-existing diagnoses of heart disease (myocardial infarction or heart failure) and kidney disease.
We estimated 1-year mortality by the Kaplan–Meier method and hazard ratios of death (HRs) during follow-up using Cox regression, controlling for confounding factors and stratified by relevant subgroups.
Among 45 018 ICU patients, 7219 (16·0%) had type 2 diabetes. Overall, 1-year mortality was 36·0% in ICU patients with type 2 diabetes, rising to 54·6% in patients with pre-existing heart and kidney diseases, compared with 29·1% in nondiabetic patients. Comparing diabetic with nondiabetic patients, the adjusted 0- to 30-day HR was 1·20 (95% confidence interval (CI): 1·13–1·26) and 1·19 (95% CI: 1·10–1·28) during the 31- to 365-day follow-up period. Pre-existing kidney disease further increased the impact of diabetes, while heart disease alone had no such effect.
ICU patients with type 2 diabetes had higher 1-year mortality compared with nondiabetic ICU patients, particularly those with pre-existing kidney disease.