Abstract
Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes.
Highlights
Diabetes represents a worldwide epidemic with high economic and social costs
The aim of our study was to assess comorbidities and prognostic factors for in-hospital and post-discharge 1-year mortality in a cohort of elderly patients with diabetes hospitalized in internal medicine and geriatric wards participating in the RePoSi registry study
RePoSi is an independent and collaborative registry, organized by the Italian Society of Internal Medicine (SIMI), IRCCS Ca’ Granda Maggiore Policlinico Hospital Foundation, and the Mario Negri Institute for Pharmacological Research, that was made up to recruit, monitor, and evaluate hospitalized older adults ≥65 years admitted to 102 Italian internal medicine and geriatric wards, with data coming from each single medical record, and collected every 2 years from 2008
Summary
Diabetes represents a worldwide epidemic with high economic and social costs. Its burden is increasing, with an estimated prevalence among adults rising from 151 million in 2000 to 536.6 million in 2021 with a prevalence of 10.5% for adults aged 20 to 79 years [1]. We showed that one of the stronger predictors of in-hospital mortality for older patients admitted in general wards was a glycemia level ≥250 mg/dL [12] Given this background, the aim of our study was to assess comorbidities and prognostic factors for in-hospital and post-discharge 1-year mortality in a cohort of elderly patients with diabetes hospitalized in internal medicine and geriatric wards participating in the RePoSi registry study. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes
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