An Elevated Glycemic Gap is Associated With Adverse Outcomes in Diabetic Patients With Community-Acquired Pneumonia

Abstract

Several studies argue against the association between admission hyperglycemia and adverse outcomes in infected diabetic patients. When investigating the association, it is necessary to consider preexisting hyperglycemia. The objective of this study was to assess whether stress-induced hyperglycemia, determined by the glycemic gap between admission glucose levels and A1c-derived average glucose levels adversely affects outcomes in diabetic patients admitted to hospital with community-acquired pneumonia (CAP).We retrospectively analyzed the glycemic gap and adverse outcomes of diabetic patients hospitalized because of CAP from June 1, 2007 to August 31, 2012 in single medical center in Taiwan.A total of 203 patients admitted with principal diagnosis of CAP and available data of glycemic gap.Patients with glycemic gaps ≥40 mg/dL had greater AUROC values for the development of adverse outcomes compared with acute hyperglycemia and long-term glycemic controls. Patients with an elevated glycemic gap had an odds ratio of 3.84 for the incidence of combined adverse outcomes. Incorporation of the glycemic gap into pneumonia severity index, CURB-65 or SMART-COP scores, increased the discriminative performance of predicting the development of adverse outcomes.Glycemic gaps were associated with adverse outcomes of diabetic CAP patients. The discriminative performance of the calculated glycemic gaps was comparable with those of current clinical scoring systems and may further increase the AUROC of each system.

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

“…A history of DM but not hyperglycemia impacts the long-term mortality associated with AECOPD 26. Our previous work showed an association between elevated glycemic gaps and adverse outcomes in patients with DM presenting with liver abscesses, community- acquired pneumonia, and acute myocardial infarction, as well as the outcomes of critically ill patients who were admitted to intensive care units (ICUs) 11–14. Consistent with these results, we again found that elevated glycemic gaps and modified stress hyperglycemia ratios were associated with the development of ARF in patients with DM during AECOPD.…”

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

“…Thirteen studies reported data on inpatients [48][49][50][51][52][53][54][55][56]58,60,61,64], two on low-risk patients [44,57] and high-risk [57,63] patients and one on outpatients [54]. Pooled event rates were 4.5% (95% CI 2.9-6.5), 0.2 (95% CI 0-0.7), 1.6 (95% CI 0.1-4.9), and 0.9 (95% CI 0.5-1.8), respectively ( Figure 3).…”

Study of glycemic gap in hyperglycemic emergencies of type 2 diabetes mellitus

“…This is in contrary to most previous results confirming the definitive negative prognostic role of glycemic gap and other SIH indices under varied disease setting like ICU, pyogenic liver abscess, community acquired pneumonia, trauma; such studies were lacking in diabetic hyperglycemic emergencies. [4][5][6][7] Nevertheless, the role of elevated glycemic gap and SIH in critically ill diabetics as well as hyperglycemic emergencies could not be entirely ruled out, as the current guidelines laid by the American College of Critical Care Medicine suggested intensive insulin therapy to maintain a tight glycemic control, thereby improving the clinical outcome of critically ill diabetics. 25…”

“…Glycemic gap has also been useful in predicting the unfavorable outcomes in diabetics with trauma and other diseases like pyogenic liver abscess, community acquired pneumonia. [5][6][7] The diagnosis and severity staging of diabetic hyperglycemic emergencies involve plasma glucose, serum osmolality, serum bicarbonate, arterial pH, anion gap, urine ketones, mental status. 2 The objective of this study is to determine the usefulness of glycemic gap as a prognostic indicator in acute hyperglycemic emergencies of T2DM.…”