Association between mortality and diabetes in patients with acute diseases treated by emergency medical services: A multicenter, prospective cohort study

Abstract

Introduction

Diabetes mellitus (DM) significantly impacts emergency medical services (EMS) and complicates acute illness prognoses. This study aimed to evaluate the effect of DM on 2-year mortality in patients admitted to emergency departments (EDs), compare diabetic and nondiabetic groups, and identify key mortality predictors.

Methods

A prospective cohort study in Spain (2019–2022) included adults with acute illnesses transported by the EMS. Diabetic patients were grouped by the presence of complications. The primary outcome was 2-year mortality; secondary outcomes included ICU and ward admissions. Survival and mortality predictors were assessed via Kaplan–Meier and Cox regression analyses.

Results

Among 5963 patients, 25.4% (n = 1513) died within a 2-year period. Mortality was significantly greater in diabetic patients with complications (41.5%) than in diabetic patients without complications (27.6%) and nondiabetic patients (21.8%) (p < 0.001). The main risk factors for mortality include advanced age and elevated lactate, leukocyte, and bilirubin levels in diabetic patients with complications. The protective factors were higher Glasgow Coma Scale (GCS) scores and hemoglobin levels. Survival curves revealed a sharp decline in the group of diabetic patients with complications during the acute phase.

Conclusion

Diabetes, particularly complications, significantly increases short- and medium-term mortality in patients with acute illnesses treated with emergency services. The results of this study highlight the need for a more thorough and early risk assessment in these patients, as the factors influencing their prognosis differ significantly from those in nondiabetic patients. This differential approach could improve clinical management and long-term outcomes.