Abstract
Aims/HypothesisThe aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs.MethodsA retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia.ResultsDuring the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18).Conclusions/InterpretationOur results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia.
Highlights
Diabetes mellitus is a chronic disorder of glucose metabolism causing serious complications, which reduce life expectancy for affected patients [1,2,3]
Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%confidence interval (CI),1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95% CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness
The two main conditions causing death explicitly as a result of impaired glycaemic control are diabetic ketoacidosis and hyperosmolar hyperglycaemic state. Both conditions are consequences of insulin shortage, increased hepatic glucose production and reduced glucose utilisation in peripheral tissues causing the potentially fatal state of hyperglycaemia [11,12].To reduce premature death exclusively related to diabetes, risk factors associated with acute hyperglycaemic events need to be further elucidated
Summary
Diabetes mellitus is a chronic disorder of glucose metabolism causing serious complications, which reduce life expectancy for affected patients [1,2,3]. The two main conditions causing death explicitly as a result of impaired glycaemic control are diabetic ketoacidosis and hyperosmolar hyperglycaemic state Both conditions are consequences of insulin shortage, increased hepatic glucose production and reduced glucose utilisation in peripheral tissues causing the potentially fatal state of hyperglycaemia [11,12].To reduce premature death exclusively related to diabetes, risk factors associated with acute hyperglycaemic events need to be further elucidated. In order to determine death caused by hyperglycaemia, biochemical analyses need to complement the forensic autopsy findings [13]. Vitreous glucose is such a biochemical analysis that has been shown to be a robust method for diagnosing antemortem hyperglycaemia [15]. The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia among individuals treated with glucose-lowering drugs (GLD)
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