Admission Hyperglycemia and Length of Hospital Stay in Patients With Diabetes and Heart Failure: A Prospective Cohort Study

Gebreegziabher, Yohannes; McCullough, Peter A.; Bubb, Chard; Loney-Hutchinson, Lesel; Makaryus, John N.; Anand, Naveen; Divakaran, Vijay; Akhrass, Philippe; Alam, Anis; Gizycki, Hans von; McFarlane, Samy I.

doi:10.1111/j.1751-7133.2008.07569.x

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…In our cohort, diabetes was associated with worse event-free survival and mortality. It is known that patients with diabetes are more likely to have heart failure [30] and have prolonged hospital length of stay when admitted for acute heart failure exacerbation [31].…”

Section: Discussionmentioning

confidence: 99%

Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation

DeLoach

Joffe

Mai

et al. 2008

Nephrology Dialysis Transplantation

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Section: Discussionmentioning

confidence: 99%

Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation

DeLoach

Joffe

Mai

et al. 2008

Nephrology Dialysis Transplantation

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“…Previous randomized controlled studies, albeit in non-COVID-19 patients, have shown a strong association between better glycemic control during the first days of hospitalization and better outcomes in patients admitted to the ICU, surgical, or medical wards. 23 , 24 , 25 A recent study examined the temporality of the association between poor glucose control on admission and throughout the first few days of hospitalization and the outcomes of COVID-19 and found a seven fold increase in mortality risk in patients with COVID-19 and severe hyperglycemia. 26 These findings highlight the importance of maintaining well-controlled glucose in patients with COVID-19 and call for the implementation of glucose management protocols such as ours to help health care providers, caring for patients with COVID-19 and dexamethasone-induced hyperglycemia, accomplish this goal as early as possible during the patient’s hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Effectiveness of a Protocol to Manage Dexamethasone-Induced Hyperglycemia Among Hospitalized Patients With COVID-19

et al. 2021

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Background Well-controlled glucose (i.e. 70-180 mg/dl) has been associated with lower mortality from COVID-19. The addition of dexamethasone to COVID-19 treatment protocols has raised concerns about the potential negative consequences of dexamethasone-induced hyperglycemia. Methods We developed a protocol to guide the management of dexamethasone-induced hyperglycemia in hospitalized patients with COVID-19. Two of the four medical teams managing patients with COVID-19 at a tertiary center used the protocol and the other two teams continued to manage hyperglycemia at the discretion of the treating physicians (“ Protocol ” and “ Control ” groups, respectively). The glycemic control and clinical outcomes in 163 patients hospitalized with COVID-19 and dexamethasone-induced hyperglycemia between July 5th and September 30th, 2020 were retrospectively reviewed and compared between the two groups. Results Compared to the “ Control ” group, the “ Protocol ” group had higher proportions of patients with well-controlled glucose across all pre-meals and bedtime glucose readings throughout the hospitalization. The differences in glycemic control between the two groups were statistically significant for fasting glucose on days 4, 5, and discharge day; pre-lunch glucose on discharge day; pre-dinner glucose on days 3, 5, and discharge day; and bedtime glucose on day 1 (all p<0.05 ). After adjusting for age, sex, nationality, BMI, Charlson score, and diabetes status; patients in the “ Protocol ” group were more likely to have well-controlled glucose compared to those in the “ Control ” group. Moreover, the in-hospital mortality was significantly lower in the “ Protocol ” group compared to the “ Control ” group (12.93 and 29.93%, respectively, p=0.01 ) Conclusions The implementation of a protocol to manage dexamethasone-induced hyperglycemia in hospitalized patients with COVID-19 resulted in more patients achieving well-controlled glucose levels and was associated with lower mortality of COVID-19.

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“…Several studies reflect the impact of hyperglycemia and patient outcomes. Gebreegziabher et al [11] conducted a prospective cohort study addressing glycaemia and length of hospital stay (LOS) in patients admitted for acute heart failure exacerbation. A significantly longer LOS was noted in patients with DM as compared with patients without diabetes (5.0 ± 0.29 vs 3.4 ± 0.19; p < .001).…”

Section: Discussionmentioning

confidence: 99%

Improved outcome of patients with diabetes mellitus with good glycemic control in the cardiac intensive care unit: a retrospective study

Sharif

Ghadir

Jakubowicz

et al. 2019

Cardiovasc Diabetol

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BackgroundDiabetes mellitus (DM) is a prevalent metabolic disease characterized by chronic hyperglycemia. A primary burden of DM is related to its long-term complications, which have been shown to impact the course of hospitalization and to influence patients’ outcome.AimTo assess the role of in-hospital glucose control on length of stay, 30-days and 1-year mortality.MethodsThis is a retrospective study that included patients admitted to the cardiac intensive care unit (CICU) of the Edith Wolfson Medical Centre between 01 January, 2010 and 31 December 2013. Blood glucose was measured by glucometer and fed into an interactive database. Glucose status was referred to as controlled when more than 50% of a given patients glucose values were between 71 and 200 mg/dL. Chisquared tests were used to assess the distribution of categorical variables, while the ttest was applied for continuous variables. A multivariate logistic regression model was used to analyze the association between glucose control and mortality. Cox regression was conducted to assess survival and 1-year mortality.Results2466 patients were admitted to the CICU over the study period, of which 370 had concomitant diabetes mellitus. Controlled glucose status was associated with shorter length of hospital stay (1.6 ± 1.7 versus 2.6 ± 3.0, p < 0.001), reduced 30-day mortality (0.7% versus 4.6%, p < 0.001), and improved 1-year mortality (2.2% versus 7.5%, p < 0.001). Moreover, attainment of glucose control was independently associated with a significant decrease in 1-year mortality (OR = 0.371, 95% CI 0.140–0.988, p = 0.047).ConclusionIn-hospital control of glucose parameters is associated with shorter length of hospital stay, and lowered 30-day and 1-year mortality. An effort to maintain glucose levels within reference ranges is warranted in critically ill patients to reduce mortality.

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Admission Hyperglycemia and Length of Hospital Stay in Patients With Diabetes and Heart Failure: A Prospective Cohort Study

Cited by 15 publications

References 26 publications

Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation

Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation

Assessment of the Effectiveness of a Protocol to Manage Dexamethasone-Induced Hyperglycemia Among Hospitalized Patients With COVID-19

Improved outcome of patients with diabetes mellitus with good glycemic control in the cardiac intensive care unit: a retrospective study

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