A Step Toward Personalized Glycemic Control*

Preiser, Jean‐Charles; Lheureux, Olivier; Prevedello, Danielle

doi:10.1097/ccm.0000000000003107

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…[7][8][9][10] Data from interventional trials have suggested that the survival benefit of the IIT was limited to patients without DM. 15,16,29 The interaction of acute and chronic glycemia has been evaluated in a group of studies that compared admission BG values to chronic glycemia estimated by measurement of HbA1c at or near hospital admission, 18 by calculating their quotient ("stress hyperglycemia ratio" 19,20 ) or their difference ("glycemic gap" 21 ). These provided a very clear signal: increasing deviation of admitting BG from chronic glycemia was strongly associated with increased mortality.…”

Section: Relationship To Prior Literaturementioning

confidence: 99%

“…Subsequent investigations have evaluated the interaction of admission BG and preadmission glycemia, derived from HbA1c measurement, 18 consistently finding that increasing divergence from chronic glycemia, rather than the absolute level of acute glycemia, was strongly associated with mortality. [19][20][21] A recently published cohort investigation evaluated the relationship of acute glucose metrics to mortality using all ICU BG data instead of just the admission BG value, and stratified patients by bands of HbA1c obtained at or near ICU admission. 22 This study reported that for patients with HbA1c < 6.5%, higher mean BG during ICU stay was associated with increased risk of death but for patients with HbA1c ≥ 8.0%, the opposite relationship was seen, with higher mean BG during ICU stay associated with reduced risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

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Acute and Chronic Glucose Control in Critically Ill Patients With Diabetes: The Impact of Prior Insulin Treatment

Krinsley

Rule²,

Brownlee

et al. 2021

J Diabetes Sci Technol

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Background: Emerging data highlight the interactions of preadmission glycemia, reflected by admission HbA1c levels, glycemic control during critical illness, and mortality. The association of preadmission insulin treatment with outcomes is unknown. Methods: This observational cohort study includes 5245 patients admitted to the medical-surgical intensive care unit of a university-affiliated teaching hospital. Three groups were analyzed: patients with diabetes with prior insulin treatment (DM-INS, n = 538); patients with diabetes with no prior insulin treatment (DM-No-INS, n = 986); no history of diabetes (NO-DM, n = 3721). Groups were stratified by HbA1c level: <6.5%; 6.5%-7.9% and >8.0%. Results: Among the three strata of HbA1c, mean blood glucose (BG), coefficient of variation (CV), and hypoglycemia increased with increasing HbA1c, and were higher for DM-INS than for DM-No-INS. Among patients with HbA1c < 6.5%, mean BG ≥ 180 mg/dL and CV > 30% were associated with lower severity-adjusted mortality in DM-INS compared to patients with mean BG 80-140 mg/dL and CV < 15%, ( P = .0058 and < .0001, respectively), but higher severity-adjusted mortality among DM-No-INS ( P = .0001 and < .0001, respectively) and NON-DM ( P < .0001 and < .0001, respectively). Among patients with HbA1c ≥ 8.0%, mean BG ≥ 180 mg/dL was associated with lower severity-adjusted mortality for both DM-INS and DM-No-INS than was mean BG 80-140 mg/dL ( p < 0.0001 for both comparisons). Conclusions: Significant differences in mortality were found among patients with diabetes based on insulin treatment and HbA1c at home and post-admission glycemic control. Prospective studies need to confirm an individualized approach to glycemic control in the critically ill.

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Section: Relationship To Prior Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute and Chronic Glucose Control in Critically Ill Patients With Diabetes: The Impact of Prior Insulin Treatment

Krinsley

Rule²,

Brownlee

et al. 2021

J Diabetes Sci Technol

Self Cite

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“…Other work has demonstrated that a long duration of time in range (70À140 mg/dL) is independently associated with survival in patients without diabetes but not in those with diabetes [64]. In addition to differences between patients with and without diabetes, there also may be differences depending on the degree of premorbid glycemic control in patients with diabetes [65]. Indeed, the glycemic threshold at which the counterregulatory mechanisms to control BG concentrations are activated is higher in patients with poorly controlled diabetes than in those with well-controlled diabetes or without diabetes.…”

Section: Personalized Treatmentmentioning

confidence: 99%

Update on glucose in critical care

2019

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The aim of this review is to summarize recent developments on the mechanisms involved in stress hyperglycemia associated with critical illness. Different aspects of the consequences of stress hyperglycemia as well as the therapeutic approaches tested so far are discussed: the physiological regulations of blood glucose, the mechanisms underlying stress hyperglycemia, the clinical associations, and the results of the prospective trials and meta-analyses to be taken into consideration when interpreting the available data. Current recommendations, challenges, and technological hopes for the future are be discussed.

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“…The "stress hyperglycemia ratio" and the "glycemic ratio" were introduced to calculate the di erence between actual and average glycemia. 23,24 The estimated average glucose value derived from glycated hemoglobin could be the optimal target range, as suggested by reports of lower mortality or reduced need for intensive care when glucose was closer to the average value. 23,24 In surgical intensive care patients, and in particular for scheduled surgeries, perioperative care should focus on the prevention of dysglycemia in order to improve outcomes.…”

mentioning

confidence: 99%

“…23,24 The estimated average glucose value derived from glycated hemoglobin could be the optimal target range, as suggested by reports of lower mortality or reduced need for intensive care when glucose was closer to the average value. 23,24 In surgical intensive care patients, and in particular for scheduled surgeries, perioperative care should focus on the prevention of dysglycemia in order to improve outcomes. The proper management of oral glucose-lowering treatment in type 2 diabetic patients is therefore crucial.…”

mentioning

confidence: 99%