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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study
Wisit Kaewput, Charat Thongprayoon, Narittaya Varothai, Anupong Sirirungreung, Ram Rangsin, Tarun Bathini, Michael A Mao, Wisit Cheungpasitporn
Wisit Kaewput, Ram Rangsin, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Charat Thongprayoon, Michael A Mao, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Narittaya Varothai, Division of Geriatrics, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand
Anupong Sirirungreung, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
Tarun Bathini, Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
Wisit Cheungpasitporn, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to conceptualization; Wisit Kaewput W contributed to conceptualization data curation; Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to formal analysis; Kaewput W and Thongprayoon C contributed to investigation; Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to methodology; Rangsin R and Sirirungreung A contributed to project administration; Rangsin R, Varothai N, Sirirungreung A, Bathini T, Mao MA and Cheungpasitporn W contributed to supervision; Kaewput W and Thongprayoon C contributed to validation; Thongprayoon C contributed to writing – original draft; Kaewput W, Thongprayoon C, Rangsin R, Varothai N, Sirirungreung A, Bathini T, Mao MA and Cheungpasitporn W contributed to writing, review and editing.
Institutional review board statement: This study was approved by both the Institutional Review Board of the Royal Thai Army Medical Department and the Ethical Review Committee for Research in Human Subjects, the Ministry of Public Health of Thailand (IRB# S007h/54). Well-trained research nurses reviewed medical records and collected data into a case record form. Data entry into the case record form was then transferred to the central data management of the Medical Research Network of the Consortium of Thai Medical Schools to adjudicate that the process of data collection was compiled according to study protocol. The data management team was responsible for inquiries to study sites to verify data. Site monitoring was randomly performed in approximately 10% of study sites.
Informed consent statement: Patients were all patients were recruited from the outpatient clinic. Written informed consent was obtained from patients before enrolment.
Conflict-of-interest statement: The authors deny any conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wisit Kaewput, MD, Academic Fellow, Assistant Professor, Doctor, Physician, Department of Military and Community Medicine, Phramongkutklao College of Medicine, 315 Ratchawithi Rd, Chang Wat, Bangkok 10400, Thailand. wisitnephro@gmail.com
Telephone: +66-235-4760093613 Fax: +66-235-47733
Received: February 14, 2019
Peer-review started: February 14, 2019
First decision: February 26, 2019
Revised: March 6, 2019
Accepted: March 11, 2019
Article in press: March 11, 2019
Published online: March 15, 2019
ARTICLE HIGHLIGHTS
Research background
The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemia-related hospitalizations, are lacking
Research motivation
This study would provide further support to the importance of regular monitoring of blood glucose, and glucose control should be individualized for the elderly T2DM patients. To further investigate the association between each variable and dysglycemia were assessed using multivariate logistic regression. Furthermore, it would motivate future research on whether more intensive monitoring of T2DM patients may allow earlier detection and prevention of dysglycemia-related hospitalization. The authors conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools.
Research objectives
We conducted this study to determine the prevalence and associated factors for hospitalizations due to dysglycemia among elderly T2DM patients in Thailand using nationwide patient sample.
Research methods
We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2014. We examined the prevalence of hospitalization due to hypoglycemia and hyperglycemia. Hyperglycemia complication included diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hyperglycemic dehydration syndrome. The association factors between dysglycemia-related hospitalizations were assessed using multivariate logistic regression.
Research results
In this study, a total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admission due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use.
Research conclusions
We found that prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand had higher than developed countries. Elderly T2DM patients, especially in patients with associated factors, should be closely monitored blood glucose.
Research perspectives
Serial blood glucose monitoring should be recommended to prevent glycemic complications especially, in the elderly T2DM patients with associated factors cannot be over-emphasized. The early intervention to prevent further complications and adequate control of diabetes is a key to the reduction of complications of diabetes itself and treatment-related complications. Among elderly T2DM patients with multiple morbidities, the glucose control should be individualized.
