Health outcomes of patients with type 2 diabetes hospitalized with cardiovascular disease: An assessment of caregivers and glycemic control.

摘要

The prevalence of diabetes mellitus continues to rise in the United States. Caregivers are known to influence health outcomes, however little is known about their role in diabetes control. This was a 1-year observational prospective analysis of 883 adult patients (59% age ≥65 years or older, 61% males and 53% minorities) with diabetes, hospitalized at a university medical center cardiovascular service, part of the Family Cardiac Caregiver Investigation to Evaluate Outcomes (FIT-O) study. The associations of having a caregiver (paid and/or unpaid) versus not having a caregiver with glycemic control (HbA1C < 7%) were examined. Similarly, the associations of having a caregiver and re-hospitalization/death at 1-year were examined. Patient caregiver status was assessed using a standardized caregiver survey. Re-hospitalization/death, demographics and patient comorbidities were documented using a hospital-based electronic health record. Prior to hospitalization, 19% (n=167) of patients had paid caregivers and 28% (n=250) had unpaid caregivers. Having any caregiver was not significantly associated with glycemic control. Patient's age ≥65 versus <65 years (p < 0.0079) was significantly associated with glycemic control. Minorities were less likely than whites to have glycemic control (p < .0001). In univariate analysis, at 1-year, having any caregiver was associated with an increased risk of death/re-hospitalization compared to not having a caregiver (OR 1.60, 95% CI 1.21 to 2.11). Patients with a Ghali comorbidity index >1, had an increased risk of re-hospitalization/death compared to a Ghali comorbidity index <1 (OR 2.83, 95% CI 2.13 to 3.75). The multivariate adjusted risk for re-hospitalization/death was 1.97 (95% CI 1.28-3.02) for having a paid caregiver. The increase in risk was no longer significant after adjustment (Ghali co-morbidity index >1, OR 2.57, 95% CI 1.90-3.48 and OR 2.12, 95% CI 1.39-3.24), suggestive of confounding by comorbidities. In conclusion, having a caregiver was not associated with glycemic control among hospitalized diabetics. Having a caregiver was associated with adverse outcomes at 1-year, attenuated by comorbidities. These data suggest caregiver status might serve as a potential indicator of adverse outcomes among hospitalized patients. This lends support for educational programs for diabetics with caregivers; however formal testing of these implications is required.