TOPLINE

Among adults with acute illnesses attended by emergency medical services, those with diabetes — particularly those with related complications — faced a significantly higher risk for 2‑year mortality than those without diabetes, whereas those with uncomplicated diabetes faced an intermediate risk.

METHODOLOGY

• Researchers performed a secondary analysis of a prospectively collected emergency medical services cohort in Spain to evaluate the effect of diabetes on 2‑year mortality, compare patients with and without diabetes, and identify mortality predictors.
• They analysed 5963 adults with unselected acute illnesses who were assessed by an advanced life support physician and transferred to emergency departments between January 2019 and October 2022.
• Patients were grouped into the following three categories on the basis of the presence of end-organ damage or vascular disease: those without diabetes (n = 4559; mean age, 64 years; 57.6% men), those with diabetes but no complications (n = 867; mean age, 76 years; 62.9% men), and those with diabetes and complications (n = 537; mean age, 77 years; 61.5% men).
• Data on demographics, comorbidities using the age-adjusted Charlson Comorbidity Index, vital signs at emergency department arrival, and laboratory blood tests were collected.

TAKEAWAY

• Overall, 25.4% of patients (n = 1513) died within 2 years.
• The risk for mortality was significantly higher among patients with diabetes but no complications (hazard ratio [HR], 1.58) and even higher among those with diabetes-related complications (HR, 2.41) than among those without diabetes (P < .001 for both).
• In patients with diabetes and complications, key risk factors for mortality included nursing home residence (HR, 1.80), higher leukocyte counts (HR, 1.13), and higher bilirubin levels (HR, 1.21); however, higher Glasgow Coma Scale verbal scores — indicating better verbal responsiveness — were protective (HR, 0.67; P < .05 for all).
• In patients with diabetes but no complications, the risk for mortality increased with older age, nursing home residence, greater comorbidity burden, faster respiratory rates, higher oxygen supplementation needs, abnormal clotting markers, elevated inflammation, and higher potassium levels; however, better oxygen saturation and verbal responsiveness were linked to improved survival.

IN PRACTICE

"The identification and utilization of the parameters obtained as risk and protective factors can help determine long-term prognosis in patients, both diabetic and nondiabetic, in emergency situations. Because these parameters are available from the earliest stages of patient assessment, they may support early risk stratification and facilitate more efficient clinical decision-making and resource allocation," the authors of the study wrote.

SOURCE

The study was led by Carmen Barbero Linares, Servicio de Salud de Castilla-La Mancha, Talavera de la Reina, Spain. It was published online on July 15, 2026, in Diabetic Medicine.

LIMITATIONS

This observational analysis of secondary data had the usual limitations, including potential information, selection, and/or measurement biases. Some analytical variables had missing values, and data on tobacco or alcohol consumption and chronic medication use were unavailable. Diabetes and diabetes with complications were identified from electronic medical records, so misclassification was possible.

DISCLOSURES

This study was supported by the Institute of Health Carlos III and co-financed by the European Union. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.