title: Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study.
abstract: OBJECTIVE
  Hyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE.
  
  
  METHODS
  This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011.
  
  
  RESULTS
  One thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97-39.27) and remained higher until 4-6 years after the HCE (IRR 1.49; 95% CI 1.23-1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors.
  
  
  CONCLUSIONS
  Patients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.
authors: Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan.
authors: Chien-Cheng
authors: CC
authors: Huang
authors: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Shih-Feng
authors: SF
authors: Weng
authors: Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan.
authors: Kang-Ting
authors: KT
authors: Tsai
authors: Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan.
authors: Ping-Jen
authors: PJ
authors: Chen
authors: Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Hung-Jung
authors: HJ
authors: Lin
authors: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Jhi-Joung
authors: JJ
authors: Wang
authors: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors: Shih-Bin
authors: SB
authors: Su
authors: Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors: Willy
authors: W
authors: Chou
authors: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan hrguo@mail.ncku.edu.tw nych2525@gmail.com.
authors: How-Ran
authors: HR
authors: Guo
authors: Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan hrguo@mail.ncku.edu.tw nych2525@gmail.com.
authors: Chien-Chin
authors: CC
authors: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000401:mortality*; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology