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In ICU, hyperglycemia’s impact greater on those without diabetes

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July 31, 2017

Compared with patients with diabetes, patients without diabetes face nearly twice the risk for death and double the length of stay after a hyperglycemic episode in the ICU, according to findings published in the Journal of Diabetes Science and Technology.

“A growing number of evidence from observational studies and prospective randomized clinical trials in patients with and without diabetes as well as in critically ill and noncritically ill patients have shown an association between stress hyperglycemia and clinical outcomes,” Simon Lebech Cichosz, PhD, and Clara Schaarup, MSc, of the department of health science and technology at Aalborg University in Denmark, wrote. “However, it is unclear whether stress hyperglycemia is the causal course of the poor outcome or if hyperglycemia is a marker of illness severity. Increasing evidence indicates an amplified risk of complications and mortality in patients without a history of diabetes compared to patients with known diagnosis of diabetes in relation to stress hyperglycemia.”

Cichosz and Schaarup analyzed data from 200,859 patients included in the eICU Collaborative Research Database, covering patients admitted to ICUs throughout the United States in 2014 and 2015. Of the 164,290 patients with registered data on diabetes status, 34,247 without diabetes and 27,458 patients with diabetes experienced at least one episode of observed hyperglycemia, defined as a blood glucose measurement of at least 180 mg/dL.

Among patients without diabetes in the ICU, the mortality rate was 17.3% for those with observed hyperglycemia vs. 6.6% for those without observed hyperglycemia (P < .001). However, among patients in the ICU with diabetes, the mortality rate was nearly 50% lower: 9% for observed hyperglycemia and 6.5% for patients without observed hyperglycemia (P < .001). Those without diabetes experiencing hyperglycemia also had a longer length of ICU stay (median, 2.7 days vs. 1.6 for those without hyperglycemia) vs. patients with diabetes (median, 1.9 days vs. 1.5 for those without hyperglycemia; P < .001 for all)

Results persisted after adjusting for age and calculated Acute Physiology and Chronic Health Evaluation (APACHE) score, according to researchers.

“One explanation could be that stress-induced hyperglycemia is a marker for severity of acute illness and that hyperglycemia caused by diabetes is not an equivalent marker,” the researchers wrote. “Another reason could be that the surveillance of glucose is more frequent when it comes to patients with diabetes, which may lead to identifying a higher prevalence of hyperglycemia without underlying deterioration of disease.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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