Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

Moyer, Eric D.; Lehman, Erik; Bolton, Matthew; Goldstein, Jennifer; Pichardo-Lowden, Ariana

doi:10.1038/s41598-021-89945-3

Cited by 2 publications

(1 citation statement)

References 62 publications

(79 reference statements)

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“…Hyperglycemia commonly occurs in critically ill patients irrespective of baseline diabetes status. 1 Stress hyperglycemia, defined as any blood glucose above 140 mg/dL in patients without evidence of previous diabetes, is estimated to develop in 11% to 12% of hospitalized patients, with an even higher incidence of 23.9% in the critically ill. [2][3][4] This has been attributed to several factors but mainly an increase in counterregulatory hormones in response to critical illness. 5 Demographic factors that may contribute to hospitalized hyperglycemia include preexisting diabetes mellitus, glucocorticoid and catecholamine use, trauma, and surgery.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Basal Plus Versus Sliding Scale Insulin Therapy on Glucose Variability in Critically Ill Patients Without Preexisting Diabetes

Webster,

Belfer,

Schmidt

2023

Ann Pharmacother

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Background: There is limited evidence evaluating the impact of insulin treatment strategies on glucose variability in critically ill patients without preexisting diabetes. Objective: Compare basal plus insulin (BPI) and sliding scale insulin (SSI) impact on glycemic control outcomes in critically ill patients without preexisting diabetes experiencing hyperglycemia. Methods: This multicenter, retrospective review analyzed critically ill patients with hyperglycemia who received either BPI or SSI. Patients with a hemoglobin A1C >6.5% during the admission of interest or in the previous 3 months, or a diagnosis of diabetes at the time of discharge were excluded. The primary outcome was glucose variability during the intensive care unit (ICU) admission. Secondary outcomes included hypoglycemia frequency, frequency of goal glucose levels, mortality, and length of stay. Results: The analysis included 228 patients (39 in BPI, 189 in SSI). Average glucose variability was higher in the BPI group compared with the SSI group (85.8 mg/dL ± 33.1 vs 70.2 mg/dL ± 30.7; P = 0.009), which remained when controlling for baseline confounding (−12.1 [5.6], 95% CI −23.2 to −0.99; P = 0.033). Hypoglycemia incidence was similar between groups. BPI patients had a lower incidence of glucose values within goal range than SSI patients ( P = 0.046). There was no difference in length of stay or hospital mortality. Conclusions and Relevance: The use of SSI compared with a BPI regimen may result in reduced glycemic variability in critically ill patients without preexisting diabetes. Future prospective studies, with a larger sample size, are warranted to confirm our exploratory findings and characterize clinically significant benefits.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Basal Plus Versus Sliding Scale Insulin Therapy on Glucose Variability in Critically Ill Patients Without Preexisting Diabetes

Webster,

Belfer,

Schmidt

2023

Ann Pharmacother

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Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19

McDonnell

Garg

Gopalakrishnan

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Purpose Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear. Methods We examined the relationship between clinical predictors including acute and chronic glycemia and clinical outcomes including ICU admission, mechanical ventilation (MV), and mortality among 1,786 individuals with diabetes or hyperglycemia (glucose > 10 mmol/l twice in 24 hrs.) admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern U.S. Results The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 ± 14.4 yrs., BMI = 31.5 ± 7.9 kg/m2, glucose = 12.0 ± 7.5 mmol/l [216 ± 135 mg/dl], and HbA1c = 8.07 ± 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (p < 0.001) and admission glucose (p = 0.014) but not HbA1c were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA1c, was a stronger predictor of mortality than either admission glucose or HbA1c alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/l, p < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher eGFR and use of any diabetes medication were associated with lower mortality (p < 0.001). Conclusions Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.

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Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

Cited by 2 publications

References 62 publications

Evaluation of Basal Plus Versus Sliding Scale Insulin Therapy on Glucose Variability in Critically Ill Patients Without Preexisting Diabetes

Evaluation of Basal Plus Versus Sliding Scale Insulin Therapy on Glucose Variability in Critically Ill Patients Without Preexisting Diabetes

Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19

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