Disclosures: The authors report no relevant financial disclosures.
April 06, 2022
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Stress hyperglycemia linked to diabetes following critical illness

Disclosures: The authors report no relevant financial disclosures.
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Among adult inpatients with transient stress hyperglycemia, the risk for subsequent diabetes development was increased compared with their normoglycemic counterparts, results of a large observational study suggested.

According to Sunny H. Wong, MD, associate professor in the department of medicine and therapeutics at the Chinese University of Hong Kong, and colleagues, stress hyperglycemia is associated with an increased risk for diabetes among survivors of critical illness. For the study, the researchers sought to determine whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia have an elevated risk for subsequent diabetes development compared with those who remained normoglycemic.

Sunny H. Wong, MD
Wong is an associate professor in the department of medicine and therapeutics at the Chinese University of Hong Kong.

The retrospective observational study included 224,534 inpatients who underwent a blood culture test for bacteria from 2010 2012. The analysis included 31,691 patients with bacteremia and 126,764 without bacteremia.

Researchers defined stress hyperglycemia according to the highest random glucose level at least 7.8 mmol/L (140 mg/dL) during the index admission period.

Diagnosis of diabetes — which was based on diagnostic codes, blood test results or medication records — served as the primary endpoint.

Researchers excluded patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and performed propensity score matching.

In the cohort of patients with bacteremia, those who had stress hyperglycemia demonstrated an increased cumulative incidence of subsequent diabetes (HR = 1.7; 95% CI, 1.2-2.4; P = .002) compared with those with normoglycemia.

“Noticeably, the cumulative incidence curves of the two groups almost overlapped in the first 2 years after the index admission but started to diverge afterward,” Wang and colleagues wrote. “This finding indicated that stress hyperglycemia in bacteremia was associated with a higher long-term incidence of diabetes.”

Results also indicated that stress hyperglycemia predicted diabetes independent of age, sex, comorbidity and other serological markers.

Among patients without bacteremia, stress hyperglycemia yielded a higher cumulative incidence of diabetes (HR = 1.4; 95% CI, 1.2-1.7; P < .001).

“This territory-wide retrospective cohort study supported that stress hyperglycemia is a risk factor for subsequent diabetes among adult inpatients,” the researchers concluded. “Recognition of an increased risk of diabetes in these patients can allow early clinical intervention.”