A U-Shape Relationship between HbA1c and All-Cause Mortality Rate in Diabetic Patients Admitted for Severe Hypoglycemia: A 15-Year, Multicenter, Retrospective Survey
Authors
Tong Zhang
Department of Endocrinology, the Third Affiliated Hospital, Nanfang Medical University, Guangzhou 510360, China
Tao Du
Department of Endocrinology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
Wangen Li
Yimei Chen
Guangda Xiang
Department of Endocrinology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China
Jianmin Ran
Department of Endocrinology, Guangzhou Red Cross Hospital, Guangzhou 510220, China
Cheng Peng
Department of Endocrinology, First Municipal People’s Hospital of Guangzhou, Guangzhou 510180, China
Hong Zhang
Institute of Endocrinology and Metabolism, the Second Xiangya Hospital of Central South University, Changsha 410011, China
Lie Feng
Department of Endocrinology, the First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
Gugen Xu
Department of Endocrinology, Guangdong No.2 Provincial People’s Hospital, Guangzhou, 510317, China
Yinghong Du
Department of Endocrinology,Guangzhou Panyu Central Hospital, Guangzhou, 511400, China
Hongbin Luo
Department of Endocrinology, Liwan Hospital of Guangzhou Medical University, Guangzhou 510170, China
Aimin Deng
Department of Endocrinology, General Hospital of Guangzhou Millitary Command of PLA, Guangzhou, 510010, China
Lu Li
Department of Endocrinology, Shenzhen Peopole’s Hospital, Jinan University, Shenzhen, 518020, China
Aims: To evaluate the association between HbA1c and mortality rate, and the cause of death during admission in diabetic patients admitted for severe hypoglycemia. Materials and Methods: From August 1998 to July 2013, we collected data from diabetic patients admitted with severe hypoglycemia at 12 middle and south China Medical Centers. The data collected includes demographic information and biochemical variables. Patients were divided into four groups according to HbA1c level: <6.0%, 6.0-6.9%, 7.0-7.9% and ³8.0%. Results: A total of 1522 diabetic patients were admitted for severe hypoglycemia during the study period, and 1117 underwent HbA1c testing. When HbA1c was<6.0%, 6.0-6.9%, 7.0-7.9% and ³8.0%, the mortality rate was 7.1%, 2.8%, 3.7% and 6.8%, respectively. A significant difference was found between HbA1c<6.0% compared with HbA1c 6.0-6.9% (χ² =7.319, P=0.007), and between HbA1c 6.0-6.9% and HbA1c³8.0% (χ²=4.805, P=0.028). In total, 57 patients died. The causes of death included infection (n=33), stroke (n=7), cardiovascular disease complicated by heart failure (n=7), diabetic nephropathy complicated by renal failure (n=6), lung cancer (n=2), a stress ulcer complicated by hemorrhage (n=1) and cirrhosis complicated by hemorrhage (n=1). Conclusions: There is a U-shape relationship between HbA1c and mortality rate during admission in diabetic patients admitted for severe hypoglycemia. Severe hypoglycemia may predict an increased risk of death in patients with lower and higher HbA1c.
