Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study

Table 1 Baseline characteristics

Characteristics	All
N	11404
Age (yr)	72.9 ± 5.5
65-75	8055 (70.6)
> 75	3349 (29.4)
Male	3594 (31.5)
Duration of diabetes (yr)	7.5 ± 4.4
Hypertension	9831 (86.2)
Dyslipidemia	8048 (70.6)
Cancer	96 (0.8)
Dementia	24 (0.2)
Depression	106 (0.9)
Cerebrovascular disease	451 (4.0)
Cardiovascular disease	1129 (9.9)
Peripheral artery disease	82 (0.7)
Peripheral neuropathy	448 (3.9)
Diabetic retinopathy	688 (6.0)
Smoking	326 (2.9)
Insulin	2385 (20.9)
BMI (kg/m2)	24.3 ± 4.3
< 17.5	391 (3.6)
17.5-22.9	3992 (36.6)
23.0-27.9	4655 (42.6)
≥ 28.0	1882 (17.2)
HbA1C (%)	7.5 ± 1.9
< 7.0	3760 (43.7)
7.0-8.5	2892 (33.6)
> 8.5	1947 (22.6)
eGFR (mL/min per 1.73 m2)	54.7 ± 21.5
≥ 60	4034 (38.5)
< 60	6448 (61.5)
Prevalence (%)
Dysglycemia-related hospitalization	558 (4.9)
Hypoglycemia-related hospitalization	356 (3.1)
Diabetic ketoacidosis related hospitalization	11 (0.1)
Hyperosmolar hyperglycemic state-related hospitalization	16 (0.1)
Hyperglycemic dehydration syndrome-related hospitalization	192 (1.7)

BMI: Body mass index; HbA1C: Hemoglobin A1C; eGFR: Estimated glomerular filtration rate.

Table 2 Crude and adjusted odds ratios of factors that were independently associated with hospital admission due to hypoglycemic complication, using multivariate analysis

Variables	Crude OR (95%CI)	P-value	Adjusted OR (95%CI)1	P-value
Age (yr)
65-75	Reference		Reference
> 75	1.87 (1.51-2.32)	< 0.001	1.79 (1.37-2.35)	< 0.001
Gender
Male	Reference		Reference
Female	1.64 (1.27-2.11)	< 0.001	1.63 (1.20-2.21)	< 0.01
Duration of diabetes (yr)	1.02 (1.01-1.03)	0.04
Hypertension	1.48 (1.04-2.11)	0.03	1.63 (1.04-2.56)	0.03
Dyslipidemia	1.10 (0.87-1.39)	0.42
Cancer	0.66 (0.16-2.68)	0.56
Dementia	6.27 (2.13-18.43)	0.001	6.98 (1.80-26.98)	< 0.01
Depression	0.29 (0.04-2.11)	0.22
Cerebrovascular disease	1.31 (0.81-2.12)	0.28
Cardiovascular disease	1.33 (0.97-1.83)	0.08
Peripheral artery disease	2.48 (1.07-5.72)	0.03
Peripheral neuropathy	1.24 (0.75-2.03)	0.40
Diabetic retinopathy	1.51 (1.04-2.20)	0.03	1.45 (0.93-2.24)	0.10
Smoking	0.58 (0.25-1.30)	0.18
Insulin	3.36 (2.71-4.15)	< 0.001	3.47 (2.61-4.60)	< 0.001
BMI (kg/m2)
< 17.5	1.80 (1.20-2.71)	<0.01	1.80 (1.12-2.90)	0.02
17.5-22.9	Reference		Reference
23.0-27.9	0.54 (0.43-0.69)	< 0.001	0.44 (0.33-0.60)	< 0.001
> 28.0	0.39 (0.27-0.57)	< 0.001	0.30 (0.19-0.48)	< 0.001
HbA1C (%)
< 7.0	Reference		Reference
7.0-8.5	1.42 (1.05-1.92)	0.02	1.41 (1.03-1.93)	0.01
≥ 8.5	1.97 (1.45-2.68)	< 0.001	1.49 (1.06-2.09)	0.02
eGFR (mL/min per 1.73 m2)
≥ 60	Reference		Reference
< 60	2.59 (1.97-3.39)	< 0.001	1.53 (1.12-2.11)	0.01

¹Adjusted for age, gender, duration of diabetes mellitus, hypertension, dyslipidemia, cancer, dementia, depression, cerebrovascular disease, coronary artery disease, peripheral artery disease, peripheral neuropathy, diabetic retinopathy, smoking, insulin, body mass index, hemoglobin A1C and estimated glomerular filtration rate using backward (Wald) method. BMI: Body mass index; HbA1C: Hemoglobin A1C; eGFR: Estimated glomerular filtration rate; OR: Odds ratio; 95%CI: 95% confidence interval.

Table 3 Crude and adjusted odds ratios of factors that were independently associated with hospital admission due to hyperglycemic complication, using multivariate analysis

Variables	Crude OR (95%CI)	P value	Adjusted OR (95%CI)1	P value
Age (yr)
65-75	Reference
> 75	0.81 (0.59-1.10)	0.18
Gender
Male	Reference
Female	0.95 (0.72-1.27)	0.74
Duration of diabetes (yr)	0.98 (0.97-1.01)	0.09
Hypertension	0.63 (0.45-0.88)	< 0.01
Dyslipidemia	0.86 (0.65-1.15)	0.31
Cancer	1.09 (0.27-4.46)	0.90
Dementia	10.44 (3.54-30.79)	< 0.001	19.08 (4.42-82.45)	< 0.001
Depression	2.58 (1.04-6.39)	0.04	3.98 (1.48-10.71)	< 0.01
Cerebrovascular disease	1.69 (0.97-2.93)	0.06
Cardiovascular disease	1.70 (1.18-2.47)	< 0.01
Peripheral artery disease	0.63 (0.09-4.56)	0.65
Peripheral neuropathy	1.70 (0.98-2.95)	0.06
Diabetic retinopathy	1.68 (1.07-2.65)	0.03
Smoking	0.80 (0.33-1.94)	0.61
Insulin	7.77 (5.85-10.32)	< 0.001	6.37 (4.30-9.45)	< 0.001
BMI (kg/m2)
< 17.5	1.79 (1.03-3.13)	0.04	1.59 (0.75-3.36)	0.23
17.5-22.9	Reference		Reference
23.0-27.9	0.73 (0.53-0.99)	0.04	0.64 (0.43-0.95)	0.03
> 28.0	0.75 (0.50-1.14)	0.18	0.62 (0.37-1.05)	0.07
HbA1C (%)
< 7.0	Reference		Reference
7.0-8.5	1.93 (1.07-3.45)	0.03	1.83 (0.99-3.40)	0.05
≥ 8.5	9.88 (6.01-16.23)	< 0.001	5.97 (3.46-10.28)	< 0.001
eGFR (mL/min per 1.73 m2)
≥ 60	Reference
< 60	2.04 (1.48-2.82)	< 0.001

¹Adjusted for age, gender, duration of diabetes mellitus, hypertension, dyslipidemia, cancer, dementia, depression, cerebrovascular disease, coronary artery disease, peripheral artery disease, peripheral neuropathy, diabetic retinopathy, smoking, insulin, body mass index, hemoglobin A1C and estimated glomerular filtration rate using backward (Wald) method. BMI: Body mass index; HbA1C: Hemoglobin A1C; eGFR: Estimated glomerular filtration rate; OR: Odds ratio; 95%CI: 95% confidence interval.

Table 4 Rate of dysglycemia related hospitalization stratified by country

Ref.	Outcome	Populations	Country	Rate of admission (per year)
Kaewput et al[13], 2019	Dysglycemia	Type 2 diabetes, age ≥ 65 years old	Thailand	3.7%
Lombardo et al[17], 2013	Dysglycemia	Any type of diabetes, subgroup; age ≥ 65 years old	Italy	6.7 per 1000 person-years
Lipska et al[7], 2014	Hypoglycemia	General population, subgroup; age ≥ 65 years old	United States	612 per 100000 person-years
Fu et al[14], 2014	Hypoglycemia	Type 2 diabetes, age ≥ 65 years old	United States	0.59 per 1000 person-years
Zhong et al[15], 2017	Hypoglycemia	Any type of diabetes, age ≥ 65 years old	England	3.52 per 1000 person-years
Clemens et al[16], 2015	Hypoglycemia	Patients with treated diabetes, age ≥ 65 years old	Canada	0.4%
Lombardo et al[17], 2013	Hypoglycemia	Any type of diabetes, all age groups	Italy	0.4 per 1000 person-years
Kim et al[19], 2016	Hypoglycemia	Type 2 diabetes, age ≥ 65 years old	Korea	9.3 per 1000 person-years
Lipska et al[7], 2014	Hyperglycemia	General population, subgroup; age ≥ 65 years old	United States	367 per 100000 person-years
Lombardo et al[17], 2013	Hyperglycemia	Any type of diabetes, all age groups	Italy	6.7 per 1000 person-years
Henriksen et al[18], 2007	Diabetic ketoacidosis	General population, all age groups	Denmark	12.9 per 100000 person-years