AIM:To compare mortality risks associated with known diabetic patients to hyperglycemic non-diabetic patients.METHODS: �ub�ed data base was searched �or pa�ub�ed data base was searched �or patients with sepsis, bacteremia, mortality and diabetes. Articles that also identi�ied new onset hyperglycemia (NOH) (�asting blood glucose > 125 mg/dL or random blood glucose > 199 mg/dL) were identi�ied and reviewed. Nine studies were evaluated with regards to hyperglycemia and hospital mortality and �ive o� the nine were summarized with regards to intensive care unit (�C�) mortality.(�C�) mortality. �C�) mortality. ) mortality. mortality. RESULTS:Historically hyperglycemia has been believed to be equally harm�ul in known diabetic patients and non-diabetics patients admitted to the hospital. �nexpectedly, having a history o� diabetes when admitted to the hospital was associated with a reduced risk o� hospital mortality. Approximately 17% o� patients admitted to hospital have NOH and 24% have diabetes mellitus. Hospital mortality was signi�icantly increased in all nine studies o� patients with NOH as compared to known diabetic patients (26.7% ± 3.4% vs 12.5% ± 3.4%, � <� �.�5�� analysis o� variance). �nad�usted �C� �.�5�� analysis o� variance). �nad�usted �C� �.�5�� analysis o� variance). �nad�usted �C� mortality was evaluated in �ive studies and was more than doubled �or those patients with NOH as compared to known diabetic patients (25.3% ± 3.3% vs 12.8% ± 2.6%, � <� �.�5) despite having similar blood glucose �.�5) despite having similar blood glucose �.�5) despite having similar blood glucose concentrations. �ost importantly, having NOH was associated with an increased �C� and a 2.7-�old increase in hospital mortality when compared to hyperglycemic diabetic patients. The mortality benefit of being diabetic is unclear but may have to do with adaptation to hyperglycemia over time. Having a history o� diabetes mellitus and prior episodes o� hyperglycemia may provide time �or the immune system to adapt to hyperglycemia and result in a reduced mortality risk. �nderstanding why diabetic patients have a lower than expected hospital mortality rate even with bacteremia or acute respiratory distress syndrome needs �urther study. CONCLUSION:Having hyperglycemia without a history o� previous diabetes mellitus is a ma�or independent risk �actor �or �C� and hospital mortality.
Prandial insulin has been essential for the improved management of the type 1 diabetic patient. Interestingly, many studies have evaluated the addition of prandial insulin to the type 2 diabetic patients with improved control. The greatest drop in A1c with the use of various type of prandial insulins have resulted in the decrease of 1.3% in the A1c measurement. Interestingly, none of the published trials with goal of fasting blood glucose (FBG) have ever obtained the goal A1c. Since a drop in FBG of 28.7mg/dl is equal to a 1% drop in A1c, a simple approach to obtain a target A1c would be to focus on the FBG (per ADA: Average Blood Glucose = A1c (%) x 28.7 - 46.7mg/d). However, average blood glucose requires multiple measurements and may be less accurate then using just a FBG. Since prandial insulin clinical trials have only demonstrated a drop in A1c by 0.3-1.3% the use of only a FBG to help patients get to goal may be easier to teach and to obtain. It might save time and money. Our hypothesis is that if patient obtain a FBG <100 mg/dl for 2-3 months then 70% will be at an A1c goal <7.0%. After a few months of good fasting glucose control the provider can use this equation (FBG+80)/30 to estimate A1c. For example, a FBG of 130mg/dl would be (130 + 80)/30 = 7.0%; or a FBG of 190 would be (190+80)/30 =eA1c 9% (estimate of A1c). While type 1 diabetes has a very complex daily glucose pattern, the approach to type 2 diabetics on insulin could become simplified.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.