title: One- and five-year risk of death and cardiovascular complications for hospitalized patients with hyperglycemia without diagnosed diabetes: An observational study.
abstract: BACKGROUND
  Hyperglycemia is recognized as an important threat to the health of patients, independent of diabetes status. However, no long-term follow-up study of patients with in-hospital elevated glucose without diabetes has been conducted.
  
  
  OBJECTIVE
  To compare 1- and 5-year risk of death and cardiovascular (CV) complications in patients with a diagnosis of diabetes versus those without a diabetes diagnosis
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Risk of all-cause death and CV complications (acute myocardial infarction [AMI], congestive heart failure [CHF], cardiovascular disease [CVD], peripheral vascular disease [PVD], and end-stage renal disease [ESRD]) in those diagnosed with diabetes versus those with different glycemia categories was determined using competing risk models.
  
  
  METHODS
  All adult patients from a tertiary hospital discharged alive between 1996 and 2008 from any service except psychiatry or obstetrics.
  
  
  RESULTS
  Compared to patients with diagnosed diabetes, patients with peak serum glucose level >200 mg/dL had significantly higher 1-year risk (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.20-1.43) and 5-year risk (HR: 1.13, 95% CI: 1.06-1.22) of death but a decreased 1-year risk of hospitalization for CHF (HR: 0.71, 95% CI: 0.62-0.81), PVD (HR: 0.20, 95% CI: 0.18-0.24), or ESRD (HR: 0.73, 95% CI: 0.6-0.89). There was no risk difference for AMI (HR: 0.96, 95% CI: 0.78-1.18) or CVD (HR: 0.79, 95% CI: 0.61-1.0).
  
  
  CONCLUSIONS
  Although it is unclear whether hospitalized patients with elevated peak serum glucose have early diabetes or their hyperglycemia reflects hospital stress or another comorbidity, in-hospital hyperglycemia is an important clinical indicator, carrying a higher 1- and 5-year mortality risk than those with diagnosed diabetes.
authors.affiliation: ICES@uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Meltem
authors.initials: M
authors.lastname: Tuna
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.forename: Nadine
authors.initials: N
authors.lastname: Lawrence
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
authors.forename: Janine
authors.initials: J
authors.lastname: Malcolm
authors.forename: Robert
authors.initials: R
authors.lastname: D Reid
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors