Case-control Investigation of Previously Undiagnosed Diabetes in the Critically Ill

被引:5
作者
Krinsley, James S. [1 ,2 ,9 ,10 ]
Roberts, Gregory [3 ]
Brownlee, Michael [4 ]
Schwartz, Michael [5 ]
Preiser, Jean-Charles [6 ]
Rule, Peter [7 ]
Wang, Yu [1 ,2 ]
Bahgat, Joseph [1 ,2 ]
Umpierrez, Guillermo E. [8 ]
Hirsch, Irl B. [5 ]
机构
[1] Stamford Hosp, Dept Med, Stamford, CT 06902 USA
[2] Columbia Vagelos Columbia Coll Phys & Surg, Stamford, CT 06902 USA
[3] Flinders Med Ctr, Dept Pharmacol, Bedford Pk, SA 5042, Australia
[4] Albert Einstein Coll Med, Dept Med, Bronx, NY 10461 USA
[5] Univ Washington, Dept Med, Sch Med, Seattle, WA 98195 USA
[6] Erasme Univ Hosp, Dept Intens Care, B-1070 Brussels, Belgium
[7] PRI Consultants, Los Altos Hills, CA 94024 USA
[8] Emory Univ, Dept Med, Sch Med, Atlanta, GA 30307 USA
[9] Stamford Hosp, Dept Med, 1 Hosp Plz, Stamford, CT 06902 USA
[10] Columbia Vagelos Columbia Coll Phys & Surg, 1 Hosp Plz, Stamford, CT 06902 USA
基金
美国国家卫生研究院;
关键词
diabetes; hyperglycemia; hypoglycemia; mortality; critically ill; glycemic ratio; IN-HOSPITAL MORTALITY; RELATIVE HYPERGLYCEMIA; CRITICAL ILLNESS; GLYCEMIC CONTROL; HEMOGLOBIN A1C; PREVALENCE; DIAGNOSIS; MARKER; IMPACT;
D O I
10.1210/jendso/bvac180
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context The outcome of patients requiring intensive care can be influenced by the presence of previously undiagnosed diabetes (undiagDM). Objective This work aimed to define the clinical characteristics, glucose control metrics, and outcomes of patients admitted to the intensive care unit (ICU) with undiagDM, and compare these to patients with known DM (DM). Methods This case-control investigation compared undiagDM (glycated hemoglobin A(1c) [HbA(1c)] >= 6.5%, no history of diabetes) to patients with DM. Glycemic ratio (GR) was calculated as the quotient of mean ICU blood glucose (BG) and estimated preadmission glycemia, based on HbA(1c) ([28.7 x HbA(1c)] - 46.7 mg/dL). GR was analyzed by bands: less than 0.7, 0.7 to less than or equal to 0.9, 0.9 to less than 1.1, and greater than or equal to 1.1. Risk-adjusted mortality was represented by the Observed:Expected mortality ratio (OEMR), calculated as the quotient of observed mortality and mortality predicted by the severity of illness (APACHE IV prediction of mortality). Results Of 5567 patients 294 (5.3%) were undiagDM. UndiagDM had lower ICU mean BG (P < .0001) and coefficient of variation (P < .0001) but similar rates of hypoglycemia (P = .08). Mortality and risk-adjusted mortality were similar in patients with GR less than 1.1 comparing undiagDM and DM. However, for patients with GR greater than or equal to 1.1, mortality (38.5% vs 10.3% [P = .0072]) and risk-adjusted mortality (OEMR 1.18 vs 0.52 [P < .0001]) were higher in undiagDM than in DM. Conclusion These data suggest that DM patients may develop tolerance to hyperglycemia that occurs during critical illness, a protective mechanism not observed in undiagDM, for whom hyperglycemia remains strongly associated with higher risk of mortality. These results may shed light on the natural history of diabetes.
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页数:12
相关论文
共 34 条
[11]  
Fleiss J., 1981, STAT METHODS RATES P
[12]   Utility of HbA1c levels for diabetes case finding in hospitalized patients with hyperglycemia [J].
Greci, LS ;
Kailasam, M ;
Malkani, S ;
Katz, DL ;
Hulinsky, I ;
Ahmadi, R ;
Nawaz, H .
DIABETES CARE, 2003, 26 (04) :1064-1068
[13]   Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up [J].
Gubitosi-Klug, Rose A. ;
Lachin, John M. ;
Backlund, Jye-Yu C. ;
Lorenzi, Gayle M. ;
Brillon, David J. ;
Orchard, Trevor J. .
DIABETES CARE, 2016, 39 (05) :686-693
[14]   The prevalence of undiagnosed diabetes mellitus and the association of baseline glycemic control on mortality in the intensive care unit: A prospective observational study [J].
Hoang, Quynh N. ;
Pisani, Margaret A. ;
Inzucchi, Silvio ;
Hu, Buqu ;
Honiden, Shyoko .
JOURNAL OF CRITICAL CARE, 2014, 29 (06) :1052-1056
[15]   Glycemic Control, Diabetic Status, and Mortality in a Heterogeneous Population of Critically Ill Patients Before and During the Era of Intensive Glycemic Management: Six and One-Half Years Experience at a University-Affiliated Community Hospital [J].
Krinsley, James S. .
SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY, 2006, 18 (04) :317-325
[16]   Relative Hypoglycemia and Lower Hemoglobin A1c-Adjusted Time in Band Are Strongly Associated With Increased Mortality in Critically Ill Patients [J].
Krinsley, James S. ;
Rule, Peter R. ;
Roberts, Gregory W. ;
Brownlee, Michael ;
Preiser, Jean-Charles ;
Chaudry, Sherose ;
Dionne, Krista D. ;
Heluey, Camilla ;
Umpierrez, Guillermo E. ;
Hirsch, Irl B. .
CRITICAL CARE MEDICINE, 2022, 50 (08) :E664-E673
[17]   Acute and Chronic Glucose Control in Critically Ill Patients With Diabetes: The Impact of Prior Insulin Treatment [J].
Krinsley, James S. ;
Rule, Peter ;
Brownlee, Michael ;
Roberts, Gregory ;
Preiser, Jean-Charles ;
Chaudry, Sherose ;
Dionne, Krista ;
Heluey-Rodrigues, Camilla ;
Umpierrez, Guillermo E. ;
Hirsch, Irl B. .
JOURNAL OF DIABETES SCIENCE AND TECHNOLOGY, 2022, 16 (06) :1483-1495
[18]   The Interaction of Acute and Chronic Glycemia on the Relationship of Hyperglycemia, Hypoglycemia, and Glucose Variability to Mortality in the Critically Ill* [J].
Krinsley, James S. ;
Rule, Peter ;
Pappy, Lovin ;
Ahmed, Afshan ;
Huley-Rodrigues, Camilla ;
Prevedello, Danielle ;
Preiser, Jean-Charles .
CRITICAL CARE MEDICINE, 2020, 48 (12) :1744-1751
[19]   SAFETY AND EFFICACY OF PERSONALIZED GLYCEMIC CONTROL IN CRITICALLY ILL PATIENTS: A 2-YEAR BEFORE AND AFTER INTERVENTIONAL TRIAL [J].
Krinsley, James S. ;
Preiser, Jean-Charles ;
Hirsch, Irl B. .
ENDOCRINE PRACTICE, 2017, 23 (03) :318-330
[20]   Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study [J].
Krinsley, James S. ;
Egi, Moritoki ;
Kiss, Alex ;
Devendra, Amin N. ;
Schuetz, Philipp ;
Maurer, Paula M. ;
Schultz, Marcus J. ;
van Hooijdonk, Roosmarijn T. M. ;
Kiyoshi, Morita ;
Mackenzie, Iain M. J. ;
Annane, Djillali ;
Stow, Peter ;
Nasraway, Stanley A. ;
Holewinski, Sharon ;
Holzinger, Ulrike ;
Preiser, Jean-Charles ;
Vincent, Jean-Louis ;
Bellomo, Rinaldo .
CRITICAL CARE, 2013, 17 (02)