title: Hypoglycemia and glycemic variability are associated with mortality in non-intensive care unit hospitalized infectious disease patients with diabetes mellitus.
abstract: OBJECTIVE
  We aimed to identify factors - glycemic control, reactive inflammatory biomarkers or vital signs - associated with mortality in diabetic patients admitted to hospital for various infections (non-intensive care unit).
  
  
  METHODS
  We retrospectively analyzed the cases of 620 diabetic patients admitted to hospital for various infections (non-intensive care unit) who underwent glucose monitoring >3 times per day. We extracted data regarding reactive inflammatory biomarkers and vital signs recorded on day 1 of hospital stay, and data on bacteremia and hypoglycemia status, glycemic variability (GV; coefficient of variation and standard deviation) and mean glucose concentrations during the entire hospital stay. Univariate and stepwise multivariate logistic regression analyses were carried out to determine the association between these factors and mortality.
  
  
  RESULTS
  The mortality rate was 10.1%. Reactive inflammatory biomarkers, vital signs and bacteremia were not associated with mortality. According to the results of the adjusted analysis, hypoglycemia showed a significant positive association with mortality, increasing death risk by 266% (odds ratio [OR] 2.66, 95% confidence interval [95% CI] 1.22-5.83; P = 0.0006). High coefficient of variation and standard deviation values were significantly associated with increased mortality, increasing death risk by 18% (OR 1.18, 95% CI 1.01-1.38; P = 0.03) and 9% (OR 1.09, 95% CI 1.01-1.18; P = 0.03), respectively. Mean glucose concentrations were also significantly associated with mortality, increasing death risk by 5% (OR 1.05, 95% CI 1.02-1.08; P = 0.0008).
  
  
  CONCLUSIONS
  Glycemic indices (especially hypoglycemia and GV), rather than reactive inflammatory biomarkers or vital signs, were associated with mortality in non-intensive care unit diabetes mellitus patients with infections.
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Takeishi
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Mori
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yumura
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shibuya
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Fushimi
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Ohashi
authors.affiliation: Department of Endocrinology and Diabetes Ichinomiyanishi Hospital Ichinomiya Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kawai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D003141:Communicable Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D048909:Diabetes Complications / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D038321:Glycemic Index; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000175:diagnosis*; D007249:Inflammation / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D012372:ROC Curve; D055986:Vital Signs
chemical_list: D015415:Biomarkers
keywords: Glycemic variability; Hypoglycemia; Mortality