Available online at www.sciencedirect.com Diabetes & Metabolism 38 (2012) 149–155 Original article Diabetes, comorbidities and increased long-term mortality in older patients admitted for geriatric inpatient care D. Zekry a , E. Frangos a , C. Graf a , J.P. Michel a , G. Gold a , K.H. Krause b , F.R. Herrmann a , U.M. Vischer a,∗ a Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, 3, chemin du Pont-Bochet, Thônex, Switzerland b Pathology and Immunology Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland Received 11 July 2011; received in revised form 5 October 2011; accepted 5 October 2011 Abstract Aims. – To study the specific impact of diabetes on long-term mortality in very old subjects with multiple comorbidities and functional disabilities. Methods. – The prevalence of vascular disorders, global comorbidity load (cumulative illness rating scale [CIRS]) and functional disabilities (activities of daily living [ADL] and Lawton’s instrumental ADL [IADL] scores) were determined according to diabetes status in a cohort of 444 patients (mean age 85.3 ± 6.7 years; 74.0% women) admitted to our geriatric service. Also, the specific impact of diabetes on 4-year mortality was analyzed using Cox proportional-hazards models. Results. – Diabetic patients had higher BMI scores (27.1 ± 4.9 vs. 23.4 ± 4.7 kg/m 2 in controls; P < 0.001), and higher prevalences of hypertension (81.9% vs. 65.1%, respectively; P = 0.003) and ischaemic heart disease (33.7% vs. 22.2%, respectively; P = 0.033), but not of stroke and renal insufficiency. They also had more comorbidities (CIRS score excluding diabetes: 15.1 ± 4.5 vs. 13.8 ± 4.8, respectively; P = 0.016) and functional disabilities. Diabetes was associated with mortality (HR: 1.42, 95% CI: 1.02–1.99; P = 0.041) after adjusting for age, gender and BMI, and this persisted after adjusting for individual vascular comorbidities, but disappeared after adjusting for CIRS, ADL or IADL scores. Conclusion. – Diabetes was associated with 4-year mortality after adjusting for the inverse relationship between mortality and BMI. This association was better accounted for by the global comorbidity load and functional disabilities than by the individual vascular comorbidities. These findings suggest that the active management of all – rather than selected – comorbidities is the key to improving the prognosis for older diabetic patients. © 2011 Elsevier Masson SAS. All rights reserved. Keywords: Diabetes; Mortality; Comorbidities; Elderly Résumé Impact du diabète et des comorbidités sur la mortalité des patients âgés hospitalisés. Objectif. – Étudier l’impact du diabète sur la mortalité des patients âgés atteints de comorbidités et d’incapacités fonctionnelles. Méthodes. – Nous avons déterminé la prévalence des atteintes vasculaires, des comorbidités cumulées (score Cumulative illness rating scale [CIRS]) et des incapacités fonctionnelles (scores ADL et IADL) selon la présence d’un diabète dans une population de 444 patients (âge moyen 85,3 ± 6,7 ans, 74,0 % femmes) admis dans notre service de gériatrie. Nous avons ensuite étudié l’impact du diabète sur la mortalité à quatre ans par des modèles de régression de Cox. Résultats. – Les patients diabétiques avaient un IMC (27,1 ± 4,9 vs 23,4 ± 4,7 kg/m 2 , P < 0,001) et une fréquence d’hypertension (81,9 vs 65,1 %, P = 0,003) et de maladies coronaires (33,7 vs 22,2 %, P = 0,033) plus élevés, mais une même fréquence d’accidents vasculaires cérébraux et d’insuffisance rénale. Ils avaient davantage de comorbidités cumulées (score CIRS sans diabète 15,1 ± 4,5 vs 13,8 ± 4,8, P = 0,016) et d’incapacités fonctionnelles. Le diabète était associé à une augmentation de la mortalité (Hazard Ratio 1,42, IC 95 % 1,02–1,99, P = 0,041) après ajustement pour l’âge, le sexe et l’IMC. Cette association persistait après ajustement pour les comorbidités vasculaires individuelles mais disparaissait après ajustement pour les scores CIRS, ADL et IADL. Abbreviations: CIRS, cumulative illness rating scale; ADL, activities of daily living; IADL, instrumental activities of daily living; IHD, ischaemic heart disease. ∗ Corresponding author. Tel.: +4122 3056310; fax: +4122 3056115. E-mail address: ulrich.vischer@hcuge.ch (U.M. Vischer). 1262-3636/$ – see front matter © 2011 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.diabet.2011.10.001 © 2021 Elsevier Masson SAS. Tous droits réservés. - Document téléchargé le 07/12/2021 Il est interdit et illégal de diffuser ce document.