# Determinants of In-Hospital Mortality Among Type 2 Diabetes Mellitus-Related Admissions in a Tertiary Teaching Hospital

## TL;DR

This study identifies that older age and specific severe conditions like infections and respiratory issues significantly increase in-hospital mortality for patients with type 2 diabetes.

## Contribution

The study provides new insights into specific clinical factors that predict mortality in hospitalized type 2 diabetes patients in a Malaysian hospital setting.

## Key findings

- In-hospital mortality among T2DM-related admissions was 4.2%.
- Older patients had a higher mortality risk (mean age 67.72 years for deceased vs. 65.11 years for survivors).
- Key mortality determinants included infections, respiratory, hepatobiliary/pancreatic, and CNS conditions.

## Abstract

What are the main findings?
In-hospital mortality among T2DM-related admissions was 4.2%, with higher risk observed among older patients (mean age 67.72 years in deceased vs. 65.11 years in survivors).Key determinants of mortality included infections and parasitic diseases, respiratory, hepatobiliary/pancreatic, and central nervous system conditions, as well as higher disease severity and comorbidity burden.

In-hospital mortality among T2DM-related admissions was 4.2%, with higher risk observed among older patients (mean age 67.72 years in deceased vs. 65.11 years in survivors).

Key determinants of mortality included infections and parasitic diseases, respiratory, hepatobiliary/pancreatic, and central nervous system conditions, as well as higher disease severity and comorbidity burden.

What are the implications of the main findings?
Clinical Implication: The strong association between infection-related, respiratory, hepatobiliary, and CNS conditions with mortality among T2DM-related admissions suggests the need for early detection and aggressive management of these comorbidities. Hospitals should implement routine screening and rapid intervention protocols for T2DM-related admissions presenting with these high-risk conditions.Healthcare System Implication: The findings highlight the importance of a multidisciplinary care approach among endocrinologists, infectious disease specialists, and intensive care teams to improve survival.

Clinical Implication: The strong association between infection-related, respiratory, hepatobiliary, and CNS conditions with mortality among T2DM-related admissions suggests the need for early detection and aggressive management of these comorbidities. Hospitals should implement routine screening and rapid intervention protocols for T2DM-related admissions presenting with these high-risk conditions.

Healthcare System Implication: The findings highlight the importance of a multidisciplinary care approach among endocrinologists, infectious disease specialists, and intensive care teams to improve survival.

Background/Objectives: Globally, type 2 diabetes mellitus (T2DM) accounts for about 90% of diabetes cases and contributes to hospital admissions and mortality in Malaysia. Identifying the determinants of in-hospital mortality is crucial for improving clinical management and resource allocation. This study aims to determine the clinical and disease-related determinants of in-hospital mortality among T2DM-related admissions in a tertiary teaching hospital. Methods: A cross-sectional study at Hospital Canselor Tuanku Muhriz (HCTM) in Kuala Lumpur involving 2838 T2DM-related admissions from the hospital casemix database. Demographic data, complications, disease group, length of stay, and number of diagnoses were analyzed. Logistic regression assessed factors associated with in-hospital mortality among T2DM-related admissions. Results: The in-hospital mortality rate among T2DM-related admissions was 4.2%. T2DM-related admissions resulting in in-hospital death involved individuals with a higher mean age (67.72 years, SD 12.06) compared to admissions that did not result in death (65.11 years, SD 11.03). Significant determinants of mortality included infections and parasitic diseases (aOR = 8.042; 95% CI: 2.999, 21.569; p < 0.001), respiratory system (aOR = 3.004; 95% CI: 1.192, 7.571; p = 0.020), hepatobiliary/pancreatic (aOR = 3.674; 95% CI: 1.143, 11.871; p = 0.029), and central nervous system (aOR = 3.484; 95% CI: 1.236, 9.826; p =0.018) conditions, and severity level 3 (aOR = 2.994; 95% CI: 1.464, 6.221; p = 0.003). Each additional diagnosis increased the mortality risk (aOR = 1.107; 95% CI: 1.032, 1.189; p = 0.005). Conclusions: Mortality among hospitalized T2DM-related admissions is driven by severe infections, respiratory, hepatobiliary, and neurological conditions, together with overall disease burden. Early identification of high-risk clinical presentations and a timely multidisciplinary approach may reduce preventable deaths among T2DM patients.