title: Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.
abstract: BACKGROUND
  Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.
  
  
  OBJECTIVE
  To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.
  
  
  METHODS
  Serial, cross-sectional observational study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  All adult, nonobstetric patients with an inpatient discharge between January 1, 2000 and December 31, 2010.
  
  
  METHODS
  We assessed in-hospital mortality; inpatient glycemic control (percentage of hospital days with glucose below 70, above 299, and between 70 and 179 mg/dL, and standard deviation of glucose measurements), and outpatient glycemic control (hemoglobin A1c).
  
  
  RESULTS
  We analyzed 322,938 admissions, including 76,758 (23.8%) with diabetes. Among 54,645 intensive care unit (ICU) admissions, there was a 7.8% relative reduction in the odds of mortality in each successive year for patients with diabetes, adjusted for age, race, payer, length of stay, discharge diagnosis, comorbidities, and service (odds ratio [OR]: 0.923, 95% confidence interval [CI]: 0.906-0.940). This was significantly greater than the 2.6% yearly reduction for those without diabetes (OR: 0.974, 95% CI: 0.963-0.985; P < 0.001 for interaction). In contrast, the greater decrease in mortality among non-ICU patients with diabetes did not reach significance. Results were similar among medical and surgical patients. Among ICU patients with diabetes, the significant decline in mortality persisted after adjustment for inpatient and outpatient glucose control (OR: 0.953, 95% CI: 0.914-0.994).
  
  
  CONCLUSIONS
  Patients with diabetes in the ICU have experienced a disproportionate reduction in mortality that is not explained by glucose control. Potential explanations include improved cardiovascular risk management or advances in therapies for diseases commonly affecting patients with diabetes.
authors: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors: Neel M
authors: NM
authors: Butala
authors: Benjamin K
authors: BK
authors: Johnson
authors: James D
authors: JD
authors: Dziura
authors: Jesse S
authors: JS
authors: Reynolds
authors: Janis E
authors: JE
authors: Bozzo
authors: Thomas J
authors: TJ
authors: Balcezak
authors: Silvio E
authors: SE
authors: Inzucchi
authors: Leora I
authors: LI
authors: Horwitz
mesh_terms: D000046:Academic Medical Centers / Q000639:trends*; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000639:trends*; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality* / Q000628:therapy; D019468:Disease Management; D005260:Female; D038321:Glycemic Index; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
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