Hyperglycemia after Trauma Increases with Age

Desai, Devang; March, R; Watters, James M.

doi:10.1097/00005373-198906000-00003

Cited by 69 publications

(27 citation statements)

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“…19 In trauma patients, age was associated with an increase in serum glucose (also related to degree of injury as reflected in Glasgow Coma Scale on admission and Injury Severity Score subsequently), but not with serum insulin. 20 Moreover, the hyperinsulinaemia typical of young and middle-aged trauma patients is thought to reflect a predominance of β-adrenergic activity, 21 which could contribute to the observed differences in the insulin responses of young and older trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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In elderly patients with AMI, hyperglycaemia is associated with increased mortality. Recently it has been observed that insulin resistance, as assessed by the HOMA index, proved an independent predictor of in-hospital mortality. The interaction between age and glucose metabolism response in the acute phase of patients with STEMI without previously known diabetes has not yet been explored. We aimed to assess this relationship in 346 consecutive patients with STEMI admitted to our ICCU after primary PCI.When compared with the other age subgroups, the very oldest patients (aged > 79 years) showed the lowest LVEF (p=0.011), the highest incidence of 2-and 3-vessel coronary artery disease (p=0.002), and, finally, the highest mortality (p=0.037). Advancing age was associated with increased values of fibrinogen (p=0.022) and ESR (p=0.001), as well as of NT-pro-BNP (p<0.001). The very oldest patients (aged > 79 years) exhibited the highest values of glycaemia and peak glycaemia, while the incidence of insulin resistance (as inferred by HOMA index) remained unchanged across the age subgroups. This glycaemic pattern was confirmed after exclusion of patients with HbA 1c > 6.5%, that is patients with a poor glycaemic control in the previous 2-3 months.In the acute phase of STEMI acute glucose metabolism is affected by age, since older patients showed the highest glucose levels and the poorest glycaemic control during ICCU stay despite the lack of differences in insulin resistance incidence.

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Section: Discussionmentioning

confidence: 99%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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“…Desai et al, most of the trauma patients were young, usually between 20-40 years old. 12 Likewise, in Iran traumatic injuries mainly occur in young men, consequently, 70% of the patients in our survey were male, most of them between 20-40 years old.…”

Section: Acir/jarcmmentioning

confidence: 61%

“…11 Another study showed that blood hyperglycemia in admission to emergency unit was in correlation with severity of trauma and leads to increased mortality and hospital length of stay. 12 BS level in first 24 h after admission can be influenced by taken drugs or type of fluid therapy. Thus, in trauma patients, BS level should be measured first they are admitted to emergency department to eliminate such effects.…”

Section: Acir/jarcmmentioning

confidence: 99%

Assessing the correlation of trauma severity, blood sugar level, and neurologic outcomes in traumatic spinal cord injury patients

Torbati¹,

Meshkini²,

Aghdam³

et al. 2015

J Anal Res Clin Med

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Trauma, due to stimulating stress responses like hormones, increases the blood sugar level (BS level). 1 by inducing neurohormonal reactions, acute trauma leads to changes in carbohydrate, protein, and fat metabolism. As it was said, by releasing special cytokines and body defense regulating hormones, trauma results in increased BS level (hyperglycemia), which significantly affects body function and treatment process. In fact, hyperglycemia is a compensatory response of the body against trauma and stress. We are aware of multifactorial etiology of hyperglycemia in trauma patients. Though it seems that activation of the sympathoadrenal system (by hypothalamus and pituitary) is the major factor of increased BS level. ac.ir/JARCMTrauma, due to stimulating stress responses like hormones, leads to increased blood sugar level (BS level), which worsens cerebrospinal and renal damages. Admission hyperglycemia associated with poor outcomes in severe traumatic injuries, therefore glucose control leads to improved outcomes and better prognosis of these patients. This study aims to analyze the impact of severity of spinal cord injury (SCI) (based on Frankel classification) on BS level in these patients. Furthermore, the effect of controlling the BS level in a normal range on improving the neurological outcomes [muscular force (MF)] was examined. This is a cross-sectional study in which admission BS level of all SCI patient, were measured, and regular treatments were applied based on standard protocols. The recovery process of motor and sensory disorders was also examined in discharge and was evaluated with the primarily measured BS level. Besides, patients with high BS level (more than 200 mg/dl) underwent the insulin protocol, and the effects of glucose level control on the final outcome of SCI patients were evaluated.Among the 380 patients enrolled in this study, 266 were male (70%) and 114 were female (30%). The mean age of patients was 35.84 ± 18-65 years old. The mean hospital length of stay was 5.98 days (from 3 to 14 days). The mean BS level in patients with MF of 0/5, 1/5, 2/5, 3/5, 4/5 and 5/5 were 169.8, 185.9, 177.3, 172.8, 117.5 and 118.0 mg/dl, respectively. The rate of MF changes was measured in hyperglycemic patients who underwent an insulin protocol.As the SCI trauma becomes more severe, the BS level increases with a higher rate. Besides, there was a significant difference (P = 0.001) in MF of patients before and after the insulin protocol prescription.

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“…It has also been documented that older people exhibit an impaired glucose response after injury characterized by a more marked increases in endogenous glucose production [44]. In trauma patients, age was associated with an increase in serum glucose (also related to degree of injury as reflected in Glasgow Coma Scale on admission and Injury Severity Score subsequently) but not with serum insulin [45]. Moreover, the hyperinsulinemia typical of young and middle-aged trauma patients is thought to reflect a predominance of β-adrenergic activity [46] and it could contribute to the observed differences in the insulin responses of young and older trauma patients.…”

Section: Aging and Acute Glucose Dysmetabolismmentioning

confidence: 99%

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

Lazzeri

Valente

Chiostri

et al. 2012

International Journal of Cardiology

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Though age is a predictor of adverse events after acute coronary syndrome, including in-hospital and posthospital mortality rates, elderly patients are under-represented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction. Several factors can account for the unfavorable outcome of the elderly, comprising increased glucose values. Diabetes is more common in the elderly patients with acute myocardial infarction in respect to younger patients and elevated glucose, though common, are rarely treated and associated with increased mortality, particularly in those without recognized diabetes. Age itself is thought to affect the acute glucose response to stress. Human aging is associated with impaired β-cell sensitivity to glucose and impaired β-cell compensation to insulin resistance and older people exhibit an impaired glucose response after injury characterized by a more marked increases in endogenous glucose production. In the early phase of ST elevation myocardial infarction (STEMI), the acute glucose response to stress comprises not only hyperglycemia but also insulin-resistance (assessed by the Homeostatic Model Assessment). Recently it has been documented in 346 STEMI patients submitted to mechanical revascularization that the acute glucose response to myocardial injury differs in respect to age, since older patients showed the highest glucose levels and the poorest glycemic control during ICCU stay in the lack of differences in insulin resistance incidence. Taking into account that aging impairs the acute glucose response to stress in elderly STEMI patients, further studies are needed to establish whether a different (more aggressive) therapeutic regime is needed in this subgroup of patients at higher risk.

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Hyperglycemia after Trauma Increases with Age

Cited by 69 publications

References 0 publications

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Assessing the correlation of trauma severity, blood sugar level, and neurologic outcomes in traumatic spinal cord injury patients

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

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