Effect of short- and long-term diabetes control on in-hospital and one year mortality rates in hospitalized patients with diabetic foot

Introduction: It remains unclear whether diabetic patients with diabetic foot complications benefit from strict glycemic control during hospitalization The present study investigates the effect of short- and long-term diabetes control on hospital outcomes including: in-hospital and one year mortality rates, length of hospital stay and the rate of repeated admissions. Methods: Type 2 diabetic patients (n = 341) were hospitalized for diabetic foot complications at Wolfson Medical Center over a 5 year period (2008–2012). The adequate short-term glycemic control was defined as average glucose levels between 110 and 180 mg/dL. HbA_1c values below 7% were defined as adequate long–term glycemic control. Results: The average glucose levels during hospitalization were 179 ± 45 mg/dL and 40% of the measurements were between 110 and 180 mg/dL. Mean admission HBA_1c levels were 8.43% ± 2.26%, and 31% of the values were below 7%. The mean length of hospital stay was 24.3 ± 22.6 days, 15.0% of the patients needed surgical intervention during admission, the in-hospital mortality rate was 10.3%, and the rate of 1-year readmission was 25.1%. Adequate diabetes control during hospitalization was not significantly associated with reduced in-hospital mortality (hazard ratio, 0.454, 95% confidence interval 0.186–1.103, p = 0.081). However, adequate diabetes control during hospitalization lead to significantly decreased one year mortality (hazard ratio, 0.269, 95% confidence interval 0.707–0.101, p = 0.009). Adequate diabetes control during hospitalization did not affect the length of hospital stay or the rate of repeated admission. Conclusions: Improved glucose control during hospital admission (levels between 110 and 180 mg/dL) was associated with reduction of one year mortality.