title: Prognostic importance of glycaemic variability on hospital mortality in patients hospitalised in Internal Medicine Departments.
abstract: BACKGROUND
  The objective was to assess the prognostic importance of various glycaemic control measures on hospital mortality.
  
  
  METHODS
  Retrospective, analytical cohort study that included patients hospitalised in internal medicine departments with a diagnosis related to diabetes mellitus (DM), excluding acute decompensations. The clinical endpoint was hospital mortality. We recorded clinical, analytical and glycaemic control-related variables (scheduled insulin administration, plasma glycaemia at admission, HbA1c, mean glycaemia (MG) and in-hospital glycaemic variability and hypoglycaemia). The measurement of hospital mortality predictors was performed using univariate and multivariate logistic regression.
  
  
  RESULTS
  A total of 384 patients (50.3% men) were included. The mean age was 78.5 (SD, 10.3) years. The DM-related diagnoses were type 2 diabetes (83.6%) and stress hyperglycaemia (6.8%). Thirty-one (8.1%) patients died while in hospital. In the multivariate analysis, the best model for predicting mortality (R(2)=0.326; P<.0001) consisted, in order of importance, of age (χ(2)=8.19; OR=1.094; 95% CI 1.020-1.174; P=.004), Charlson index (χ(2)=7.28; OR=1.48; 95% CI 1.11-1.99; P=.007), initial glycaemia (χ(2)=6.05; OR=1.007; 95% CI 1.001-1.014; P=.014), HbA1c (χ(2)=5.76; OR=0.59; 95% CI 0.33-1; P=.016), glycaemic variability (χ(2)=4.41; OR=1.031; 95% CI 1-1.062; P=.036), need for corticosteroid treatment (χ(2)=4.03; OR=3.1; 95% CI 1-9.64; P=.045), administration of scheduled insulin (χ(2)=3.98; OR=0.26; 95% CI 0.066-1; P=.046) and systolic blood pressure (χ(2)=2.92; OR=0.985; 95% CI 0.97-1.003; P=.088).
  
  
  CONCLUSIONS
  An increase in initial glycaemia and in-hospital glycaemic variability predict the risk of mortality for hospitalised patients with DM.
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España. Electronic address: danielsaenzabad@hotmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Sáenz-Abad
authors.affiliation: Servicio de Endocrinología, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Gimeno-Orna
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España.
authors.forename: J I
authors.initials: JI
authors.lastname: Pérez-Calvo
keywords: Diabetes; Glycaemic variability; Hospital management of hyperglycaemia; Hospital mortality; Insulin; Insulina; Manejo hospitalario de la hiperglucemia; Mortalidad hospitalaria; Variabilidad glucémica