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Stress hyperglycemia and newly diagnosed diabetes in 2124 patients hospitalized with pneumonia.
Am J Med. 2012 Oct; 125(10):1036.e17-23.AJ

Abstract

OBJECTIVE

Our goal was to determine the association between random admission hyperglycemia and new diagnosis of diabetes after discharge in patients hospitalized with pneumonia.

METHODS

Clinical data, including the Pneumonia Severity Index, were prospectively collected on all 2124 patients without diabetes admitted with pneumonia to 6 hospitals in Edmonton, Alberta, Canada. Admission glucose was classified as: normal (4.0-6.0 mmol/L, reference group) versus mild (6.1-7.7 mmol/L), moderate (7.8-11.0 mmol/L), and severe (11.1-20.0 mmol/L) stress hyperglycemia. New diagnosis of diabetes over 5 years was ascertained using well-validated criteria within linked administrative databases. Multivariable Cox models were used, and sensitivity, specificity, and likelihood ratios were calculated.

RESULTS

Mean age was 68 years; 1091 (51%) were male, and 1418 (67%) had stress hyperglycemia. Over 5 years, 194 (14%) with stress hyperglycemia were diagnosed with diabetes. Compared with the 45 of 706 (6%) incidences of diabetes in normal glycemia patients (4.0-6.0 mmol/L), a strong graded increase in risk of new diabetes existed with increasing hyperglycemia: mild (59 of 841 [7%]; adjusted hazard ratio [aHR] 1.09; 95% confidence interval [CI], 0.74-1.61) versus moderate (86 of 473 [18%]; aHR 2.99; 95% CI, 2.07-4.31) versus severe (49 of 104 [47%]; aHR 11.43; 95% CI, 7.50-17.42). Among moderate-to-severe hyperglycemia (≥7.8 mmol/L) patients, the sensitivity, specificity, and positive and negative likelihood ratios for new diabetes were 57%, 77%, 2.1, and 0.6, respectively, with a number-needed-to-evaluate of 5 to detect one new case of diabetes.

CONCLUSION

Moderate-to-severe random hyperglycemia in pneumonia patients admitted to the hospital is strongly associated with new diagnosis of diabetes. Opportunistic evaluation for diabetes may be warranted in this group.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22863217

Citation

MacIntyre, Erika J., et al. "Stress Hyperglycemia and Newly Diagnosed Diabetes in 2124 Patients Hospitalized With Pneumonia." The American Journal of Medicine, vol. 125, no. 10, 2012, pp. 1036.e17-23.
MacIntyre EJ, Majumdar SR, Gamble JM, et al. Stress hyperglycemia and newly diagnosed diabetes in 2124 patients hospitalized with pneumonia. Am J Med. 2012;125(10):1036.e17-23.
MacIntyre, E. J., Majumdar, S. R., Gamble, J. M., Minhas-Sandhu, J. K., Marrie, T. J., & Eurich, D. T. (2012). Stress hyperglycemia and newly diagnosed diabetes in 2124 patients hospitalized with pneumonia. The American Journal of Medicine, 125(10), e17-23. https://doi.org/10.1016/j.amjmed.2012.01.026
MacIntyre EJ, et al. Stress Hyperglycemia and Newly Diagnosed Diabetes in 2124 Patients Hospitalized With Pneumonia. Am J Med. 2012;125(10):1036.e17-23. PubMed PMID: 22863217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stress hyperglycemia and newly diagnosed diabetes in 2124 patients hospitalized with pneumonia. AU - MacIntyre,Erika J, AU - Majumdar,Sumit R, AU - Gamble,John-Michael, AU - Minhas-Sandhu,Jasjeet K, AU - Marrie,Thomas J, AU - Eurich,Dean T, Y1 - 2012/08/02/ PY - 2011/09/01/received PY - 2011/12/30/revised PY - 2012/01/11/accepted PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/12/10/medline SP - 1036.e17 EP - 23 JF - The American journal of medicine JO - Am. J. Med. VL - 125 IS - 10 N2 - OBJECTIVE: Our goal was to determine the association between random admission hyperglycemia and new diagnosis of diabetes after discharge in patients hospitalized with pneumonia. METHODS: Clinical data, including the Pneumonia Severity Index, were prospectively collected on all 2124 patients without diabetes admitted with pneumonia to 6 hospitals in Edmonton, Alberta, Canada. Admission glucose was classified as: normal (4.0-6.0 mmol/L, reference group) versus mild (6.1-7.7 mmol/L), moderate (7.8-11.0 mmol/L), and severe (11.1-20.0 mmol/L) stress hyperglycemia. New diagnosis of diabetes over 5 years was ascertained using well-validated criteria within linked administrative databases. Multivariable Cox models were used, and sensitivity, specificity, and likelihood ratios were calculated. RESULTS: Mean age was 68 years; 1091 (51%) were male, and 1418 (67%) had stress hyperglycemia. Over 5 years, 194 (14%) with stress hyperglycemia were diagnosed with diabetes. Compared with the 45 of 706 (6%) incidences of diabetes in normal glycemia patients (4.0-6.0 mmol/L), a strong graded increase in risk of new diabetes existed with increasing hyperglycemia: mild (59 of 841 [7%]; adjusted hazard ratio [aHR] 1.09; 95% confidence interval [CI], 0.74-1.61) versus moderate (86 of 473 [18%]; aHR 2.99; 95% CI, 2.07-4.31) versus severe (49 of 104 [47%]; aHR 11.43; 95% CI, 7.50-17.42). Among moderate-to-severe hyperglycemia (≥7.8 mmol/L) patients, the sensitivity, specificity, and positive and negative likelihood ratios for new diabetes were 57%, 77%, 2.1, and 0.6, respectively, with a number-needed-to-evaluate of 5 to detect one new case of diabetes. CONCLUSION: Moderate-to-severe random hyperglycemia in pneumonia patients admitted to the hospital is strongly associated with new diagnosis of diabetes. Opportunistic evaluation for diabetes may be warranted in this group. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/22863217/Stress_hyperglycemia_and_newly_diagnosed_diabetes_in_2124_patients_hospitalized_with_pneumonia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(12)00162-3 DB - PRIME DP - Unbound Medicine ER -