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The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes.
Crit Care Med. 2011 Jan; 39(1):105-11.CC

Abstract

OBJECTIVES

The relationship between hyperglycemia and mortality is altered by the presence of diabetes mellitus. Biological adjustment to preexisting hyperglycemia might explain this phenomenon. We tested whether the degree of preexisting hyperglycemia would modulate the association between glycemia and outcome during critical illness in patients with diabetes mellitus.

DESIGN

Retrospective observational study.

SETTING

Two tertiary intensive care units.

PATIENTS

Four hundred fifteen critically ill diabetic patients with HbA1c levels measured within 3 months of intensive care unit admission.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There were 9,946 blood glucose measurements in this study cohort (glucose measured 6.7 times per day; every 3.6 hrs on average). The median preadmission HbA1c level was 7.0%. There was no significant difference in HbA1c levels (p = .17) or time-weighted average of blood glucose concentrations (p = .49) between survivors and nonsurvivors. The time-weighted average of blood glucose concentrations during intensive care unit stay for nonsurvivors was lower than that of survivors when the HbA1c was >6.8%. In multivariate analysis, we found that there was a significant interaction between HbA1c and the time-weighted glucose level, indicating that the relationship between HbA1c and mortality changed according to the levels of time-weighted average of blood glucose concentrations (p = .008). As a consequence, in patients with higher (>7%) preadmission levels of HbA1c, the higher the time-weighted acute glucose concentration during intensive care unit stay (>10 mmol/L), the lower the hospital mortality compared with the lower HbA1c cohort (<7%).

CONCLUSIONS

In patients with diabetes mellitus admitted to intensive care units, there was a significant interaction between preexisting hyperglycemia and the association between acute glycemia and mortality. These observations generate the hypothesis that glucose levels that are considered safe and desirable in other patients might be undesirable in diabetic patients with chronic hyperglycemia. Further studies are required to confirm or refute our findings.

Authors+Show Affiliations

Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20975552

Citation

Egi, Moritoki, et al. "The Interaction of Chronic and Acute Glycemia With Mortality in Critically Ill Patients With Diabetes." Critical Care Medicine, vol. 39, no. 1, 2011, pp. 105-11.
Egi M, Bellomo R, Stachowski E, et al. The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. Crit Care Med. 2011;39(1):105-11.
Egi, M., Bellomo, R., Stachowski, E., French, C. J., Hart, G. K., Taori, G., Hegarty, C., & Bailey, M. (2011). The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. Critical Care Medicine, 39(1), 105-11. https://doi.org/10.1097/CCM.0b013e3181feb5ea
Egi M, et al. The Interaction of Chronic and Acute Glycemia With Mortality in Critically Ill Patients With Diabetes. Crit Care Med. 2011;39(1):105-11. PubMed PMID: 20975552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. AU - Egi,Moritoki, AU - Bellomo,Rinaldo, AU - Stachowski,Edward, AU - French,Craig J, AU - Hart,Graeme K, AU - Taori,Gopal, AU - Hegarty,Colin, AU - Bailey,Michael, PY - 2010/10/27/entrez PY - 2010/10/27/pubmed PY - 2011/2/8/medline SP - 105 EP - 11 JF - Critical care medicine JO - Crit Care Med VL - 39 IS - 1 N2 - OBJECTIVES: The relationship between hyperglycemia and mortality is altered by the presence of diabetes mellitus. Biological adjustment to preexisting hyperglycemia might explain this phenomenon. We tested whether the degree of preexisting hyperglycemia would modulate the association between glycemia and outcome during critical illness in patients with diabetes mellitus. DESIGN: Retrospective observational study. SETTING: Two tertiary intensive care units. PATIENTS: Four hundred fifteen critically ill diabetic patients with HbA1c levels measured within 3 months of intensive care unit admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 9,946 blood glucose measurements in this study cohort (glucose measured 6.7 times per day; every 3.6 hrs on average). The median preadmission HbA1c level was 7.0%. There was no significant difference in HbA1c levels (p = .17) or time-weighted average of blood glucose concentrations (p = .49) between survivors and nonsurvivors. The time-weighted average of blood glucose concentrations during intensive care unit stay for nonsurvivors was lower than that of survivors when the HbA1c was >6.8%. In multivariate analysis, we found that there was a significant interaction between HbA1c and the time-weighted glucose level, indicating that the relationship between HbA1c and mortality changed according to the levels of time-weighted average of blood glucose concentrations (p = .008). As a consequence, in patients with higher (>7%) preadmission levels of HbA1c, the higher the time-weighted acute glucose concentration during intensive care unit stay (>10 mmol/L), the lower the hospital mortality compared with the lower HbA1c cohort (<7%). CONCLUSIONS: In patients with diabetes mellitus admitted to intensive care units, there was a significant interaction between preexisting hyperglycemia and the association between acute glycemia and mortality. These observations generate the hypothesis that glucose levels that are considered safe and desirable in other patients might be undesirable in diabetic patients with chronic hyperglycemia. Further studies are required to confirm or refute our findings. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/20975552/The_interaction_of_chronic_and_acute_glycemia_with_mortality_in_critically_ill_patients_with_diabetes_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181feb5ea DB - PRIME DP - Unbound Medicine ER -