Effect of short- and long-term diabetes control on in-hospital and one year mortality rates in hospitalized patients with diabetic foot.

INTRODUCTION

It remains unclear whether diabetic patients with diabetic foot complications benefit from strict glycemic control during hospitalization The present study investigates the effect of short- and long-term diabetes control on hospital outcomes including: in-hospital and one year mortality rates, length of hospital stay and the rate of repeated admissions.

METHODS

Type 2 diabetic patients (n = 341) were hospitalized for diabetic foot complications at Wolfson Medical Center over a 5 year period (2008-2012). The adequate short-term glycemic control was defined as average glucose levels between 110 and 180 mg/dL. HbA1c values below 7% were defined as adequate long-term glycemic control.

RESULTS

The average glucose levels during hospitalization were 179 ± 45 mg/dL and 40% of the measurements were between 110 and 180 mg/dL. Mean admission HBA1c levels were 8.43% ± 2.26%, and 31% of the values were below 7%. The mean length of hospital stay was 24.3 ± 22.6 days, 15.0% of the patients needed surgical intervention during admission, the in-hospital mortality rate was 10.3%, and the rate of 1-year readmission was 25.1%. Adequate diabetes control during hospitalization was not significantly associated with reduced in-hospital mortality (hazard ratio, 0.454, 95% confidence interval 0.186-1.103, p = 0.081). However, adequate diabetes control during hospitalization lead to significantly decreased one year mortality (hazard ratio, 0.269, 95% confidence interval 0.707-0.101, p = 0.009). Adequate diabetes control during hospitalization did not affect the length of hospital stay or the rate of repeated admission.

CONCLUSIONS

Improved glucose control during hospital admission (levels between 110 and 180 mg/dL) was associated with reduction of one year mortality.