title: A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality: a prospective, observational cohort study.
abstract: OBJECTIVE
  Hyperglycaemia is very common during exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, its clinical significance is not clear. The objective of the present study was to assess whether exacerbation-associated hyperglycaemia affects long-term mortality in these patients.
  
  
  METHODS
  A prospective, observational cohort study.
  
  
  METHODS
  A single hospital in eastern Finland.
  
  
  METHODS
  153 consecutive patients who were hospitalised due to mild to moderate obstructive lung disease exacerbation (110 with asthma and 43 with COPD) and who survived at least 30 days.
  
  
  METHODS
  Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The median follow-up time was 6 years and 2 months.
  
  
  RESULTS
  During the follow-up, 57 (37%) of the patients died. Previously diagnosed diabetes was strongly associated with elevated mortality (adjusted HR (aHR) 3.03 (1.28 to 7.18). The highest fasting glucose value (aHR 1.10 (1.01 to 1.20) per 1 mmol/L) and the highest postprandial glucose value ((aHR 1.07 (1.00 to 1.16)) were also associated with late mortality. However, the associations between highest glucose values and mortality vanished when the diagnosis of diabetes was included in the same model. Within the patients without diabetes, neither fasting (aHR 0.92 (0.42 to 2.02)) nor postprandial ((aHR 1.04 (0.50 to 2.12)) hyperglycaemia was associated with late mortality. There were no statistically significant differences in the underlying causes of death between the patients with and without diabetes.
  
  
  CONCLUSIONS
  A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality.
authors: Pulmonary Division, Unit for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Kuopio, Finland.
authors: Heikki O
authors: HO
authors: Koskela
authors: Pulmonary Division, Unit for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland.
authors: Päivi H
authors: PH
authors: Salonen
authors: Eastern Finland Laboratory Centre, Kuopio, Finland.
authors: Jarkko
authors: J
authors: Romppanen
authors: Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Kuopio, Finland Finnish Medicines Agency Fimea, Helsinki, Finland.
authors: Leo
authors: L
authors: Niskanen
mesh_terms: D000208:Acute Disease; D000368:Aged; D001249:Asthma / Q000097:blood / Q000150:complications; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: RESPIRATORY MEDICINE (see Thoracic Medicine)
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