Hypoglycemia but Not Hyperglycemia Is Associated with Mortality in Critically Ill Patients with Diabetes

Abstract

Background: Both severe hyperglycemia (> 200 mg/dL) and hypoglycemia (≤70 mg/dL) are known to be associated with increased mortality in critically ill patients. Therefore, we investigated associations of a single episode of blood glucose deviation (concentration either ≤70 mg/dL and/or > 200 mg/dL) during an intensive care unit (ICU) stay with mortality in these patients. Methods: A total of 4,986 patients (age 65 ± 15 years; 39% female; 14% type 2 diabetes [T2DM] based on medical records) admitted to a German ICU in a tertiary care hospital were investigated retrospectively. The intra-ICU and long-term mortality of patients between 4 and 7 years after their ICU submission were assessed. Results: A total 62,659 glucose measurements were analyzed. A single glucose deviation was associated with adverse outcomes compared to patients without a glucose deviation, represented by both intra-ICU mortality (22 vs. 10%; OR 2.62; 95% CI 2.23–3.09; p < 0.001) and long-term mortality (HR 2.01; 95% CI 1.81–2.24; p < 0.001). In patients suffering from T2DM hypoglycemia (30 vs. 13%; OR 2.94; 95% CI 2.28–3.80; p < 0.001) but not hyperglycemia (16 vs. 14%; OR 1.05; 95% CI 0.68–1.62; p = 0.84) was associated with mortality. Conclusion: In patients with dia­betes, hypo- but not hyperglycemia was associated with increased mortality, whereas in patients without diabetes, both hyper- and hypoglycemia were associated with adverse outcome. Blood glucose concentration might need differential approaches depending on concomitant diseases.

Glucose management in critically ill adults: A qualitative study from the experiences of health care providers

“…In addition to the change in glycaemic control methods before and after admission to the ICU, patients with a history of diabetes are more prone to glycaemic-related complications [ 30 ]. Some researchers have pointed out that the severity of hypoglycaemia in patients with a history of diabetes is greater than that in patients without a history of diabetes [ 31 ].…”

Incidence and Impact of Dysglycemia in Patients with Sepsis Under Moderate Glycemic Control

“…In patients with pre-existing diabetes, dissimilar correlations between blood glucose levels and outcomes were reported. In critically ill diabetic patients, hypoglycemia was found to be associated with a higher mortality rate (28,29). Regarding sepsis, some studies demonstrated a risk of admission hyperglycemia, whereas other studies reported only a risk of early hypoglycemia (15,23,30).…”

Hypothesis: Enhanced glucose availability and insulin resistance enhances an activated immune system and accounts for the obesity paradox

“…The impact of a single episode of blood glucose deviation (concentration <70 and/or >200 mg/dL) during ICU stay in patients with sepsis, AMI and congestive heart failure found that for patients suffering from type 2 diabetes mellitus (T2DM), hypoglycaemia (odds ratio = 2.94) but not hyperglycaemia was associated with increased mortality. In patients without T2DM, both hyper‐ and hypoglycaemia were associated with adverse outcomes 51 . For type 2 diabetes patients, the diabetes‐related complication was the major determinant of hospital mortality rather than diabetes per se, HbA1c level or initial blood glucose level.…”

“…In patients without T2DM, both hyper-and hypoglycaemia were associated with adverse outcomes. 51 For type 2 diabetes patients, the diabetes-related complication was the major determinant of hospital mortality rather than diabetes per se, HbA1c level or initial blood glucose level. Initial blood glucose levels did not differ significantly between surviving and deceased diabetic sepsis patients.…”