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Long-Term Mortality Higher in Patients with Diabetes and COPD
Patients with a confirmed physician's diagnosis of diabetes had a higher risk of long-term mortality after a mild to moderate exacerbation of chronic obstructive pulmonary disease (COPD), according to the results of a recent study [BMJ Open. 2015;5(1):e006794].
“The majority of patients hospitalized due to acute asthma or COPD demonstrate hyperglycemia,” Heikki O. Koskela, MD, Kuopio University Hospital, Kuopio, Finland, told First Report Managed Care in an interview. Evidence has shown as many as 79% of patients show fasting or postprandial hyperglycemia during an exacerbation and as many as 96% of patients with diabetes experience hyperglycemia during an exacerbation. “However, the clinical significance of this phenomenon is unknown,” said Dr. Koskela.
Dr. Koskela and colleagues conducted a prospective, observational, cohort study to examine whether exacerbation-associated hyperglycemia had an impact on late mortality in patients with either asthma or COPD. They also evaluated whether there was a relationship between diabetes and the medication metformin to late mortality.
Adult patients admitted to Kuopio University Hospital with an acute exacerbation of asthma or COPD between November 2006 and May 2008 were eligible for study inclusion, with 153 included in the final analysis. The median follow-up was 6 years and 2 months. Of the total study population, 110 (72%) had probable asthma and 43 (28%) had probable COPD. Plasma glucose levels were measured 7 times in the first 24 hours of hospitalization and the patients’ family history of diabetes was established. Height, weight, waist circumference, oxygen saturation, blood pressure, temperature, and heart rate were also evaluated at admission.
All patients were given oral prednisolone tablets and inhaled salbutamol, and antibiotics were prescribed if deemed necessary by the attending physician. Patients who were taking metformin did not continue taking it during hospitalization but continued after discharge.
Of the 153 patients included in the analysis, 23 had a physician’s diagnosis of diabetes; 20 had a screening diagnosis of diabetes (glycated hemoglobin ≥6.5% at admission but no physician diagnosis of diabetes); and 110 patients had no form of diabetes. Results showed fasting hyperglycemia in 91%, 90%, and 62% of the patients in each group, respectively; postprandial hyperglycemia occured in occurred in 83%, 80%, and 54%, respectively. Among patients with a physician’s diagnosis of diabetes, 14 were on metformin, 7 took sulfonylureas, and 10 used insulin.
The researchers found a previous physician’s diagnosis of diabetes to be significantly associated with late mortality (adjusted hazard ratio, 3.03). A screening diagnosis of diabetes, however, had no correlation. The highest fasting and postprandial glucose values had a modest association with late mortality.
By the end of follow-up, results showed 38 of 110 patients without diabetes had died; 11 of the 23 patients with a physician diagnosis of diabetes had died; and 8 of the 20 patients with a screening diagnosis of diabetes had died.
Limitations of the study included the relatively small number of patients, which has the potential of causing type 2 statistical errors.—Mary Mihalovic
