Posted Sep 20 , 2018 03:38 AM

Excess risk of hospitalisation for heart failure among people with type 2 diabetes

Rosengren A, et al. Diabetologia 2018_onlie 09 August

What were the findings (excerpted from the Abstract)?

Type 2 diabetes is an established risk factor for heart failure, but age-specific data are sparse. We aimed to determine excess risk of heart failure, based on age, glycemic control and kidney function in comparison with age- and sex matched control individuals from the general population. Individuals with type 2 diabetes registered in the Swedish National Diabetes Registry 1998–2012. The authors identified 266,305 individuals with type 2 diabetes (mean age 62.0 years, 45.3% women) and 1,323,504 age, sex, and county of residence matched control individuals who were followed for an average of 5.6 years till the end of 2013. Of the individuals with type 2 diabetes and control individuals, 18,715 (7.0%) and 50,157 (3.8%) were hospitalized with a diagnosis of heart failure, respectively. Comparing individuals with diabetes with those in the control group, men and women with type 2 diabetes who were younger than 55 years of age had hazard ratios for hospitalisation for heart failure of 2.07 and 4.59, respectively, using analyses adjusted for socioeconomic variables and associated conditions. Younger age, poorer glycemic control and deteriorating renal function were all associated with increased excess risk of heart failure in those with type 2 diabetes compared with the control group. However, people with diabetes who were ≥75 years and without albuminuria or with good glycemic control (HbA1c ≤6.9%) had a similar risk of hospitalisation for heart failure as control individuals in the same age group.

Why is this important?

Men and women aged <55 years with type 2 diabetes are at markedly elevated excess risk of heart failure. The excess risk declined with age, but persisted even with good glycemic control. However, among those who were 75 years and older, diabetic individuals with well controlled glucose levels or without albuminuria had a risk of heart failure that was on a par with individuals without diabetes. Hospitals are penalized by Medicare for heart failure readmissions within 30 days of previous hospitalization. Diabetes is an important risk factor for heart failure and good glucose control is one of many avenues to lessen the risk of hospitalization. Does the hospital you work with have a program to reduce re-admissions for heart failure? Does it address diabetes control?

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