Investigation on Risk Factors Associated with Diabetic Deaths–A Hospital-based Cases Management
| Autor: | Mei-Jung Lin, 林美蓉 |
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| Rok vydání: | 2009 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 97 Objectives : This study investigated the clinical factors that were associated with death from diabetes. Among the patients enrolled in diabetes case management, those who had died were compared with the surviving cases to evaluate potential factors that predict the mortality. Findings can be adapted to improve the care of diabetic patients. Methods : The study subjects consisted of dead patients and the surviving cases who had completed at least a year of diabetes education at our hospital’s diabetes case management program in 2002 - 2006. The baseline personal data included age, gender, disease duration, medications, and co-morbidity (hypertension and hyperlipidemia). The laboratory measures were extracted from medical records including hemoglobin A1c (HbA1c), lipid profile (total cholesterol, triglyceride, and low density lipoproteins cholesterol) and microalbumin rate (ACR), and clinic examines included ankle brachial index (ABI), pulse wave velocity (PWV), non-mydriatic retino-photo (NMRP) and Michigan neuropathy score. Differences between dead subjects and surviving subjects were compared using t-test and Chi-square test. Linear Logistic regression was used to identify risk factors related to the death. P < 0.05 was defined to statistic significance. The receiver operating characteristics (ROC) curve was used to establish ACR positive predictive value for determining the cut-off point value. Results : Among 7207 patients participating in the diabetes case management program, 189 cases were selected from 497 dead cases and 754 surviving subjects were selected matched with age. The mean ages were 73.6 years (SD, 9.58) in dead subjects (51.9% males, 48.1% females) and 72.0 years (SD, 9.11) in surviving subjects(45.2% males, 54.8% females). The results showed that the distributions in gender, DM duration, lipid profile, HbA1c and PWV were not significantly different between the 2 groups. Age, ABI, medication use and neuropathy were significantly higher in the dead group than in the survivals. Mean albumin creatinine ratio and neuropathy score were significantly better in the survivals. In death subjects, the elevated albumin creatinine ratio indicated a more complicated status. Data analysis showed an elevated mortality in patients with micro-vascularpathy. The ROC curve established the ACR positive predictive value with a cut-off point at 64.9µg/mg and 63.1% of predictive rate. Conclusion : Diabetic patients with chronic nephropathy are at an elevated risk of mortality, particularly when ACR increases to 64.9 µg/mg. Diabetic care with adequate risk factor control and case management may reduce the risk of death. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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