Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes

Abstract

Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

“…Evidence is mounting that hyperglycaemia is a predictor of mortality and complications, and that even a moderate increase in blood glucose may be associated with a worse outcome 22, 23, 24. Patients with fasting blood glucose concentrations > 7 mmol/l or random blood glucose concentrations > 11.1 mmol/l on general surgical wards showed a 18‐fold increased in‐hospital mortality, a longer hospital stay and a greater risk of infection 25. Post‐operative protein catabolism is characterised by a net loss of functional and structural body protein.…”

Post-operative insulin resistance

“…У 38% паци-ентов была выявлена гипергликемия, и лишь 26% из них имели СД в анамнезе. Пациенты с впервые выявленной гипергликемией имели более высокий уровень летально-сти (16%) при сравнении с пациентами, имеющими СД (3%) и нормогликемию (1,7%) [8].…”

“…большое внимание ИР после хирургической операции стали уделять в связи с выявленными неблаго-приятными эффектами стрессовой гипергликемии (СГ) у пациентов хирургического и кардиохирургического профиля, а также у пациентов в отделениях интенсивной терапии [7][8][9].…”

Glucose Control in the Critically Ill Patient Utilizing Computerized Intravenous Insulin Dosing

“…1,2 This is particularly true in the critically ill patient admitted to the intensive care unit (ICU). [3][4][5][6][7][8][9] Critically ill patients who require ICU care for more than five days have as high as a 20% risk of death and significant morbidity.…”

“…1,12 Adverse outcomes have been reported in various critically ill populations. [3][4][5]8,9 In several patient populations, improved morbidity and mortality has been reported at blood glucose ranges defined as 'tight' (glucose 80-110mg/dl) or those below 140mg/dl.…”