Dynamic properties of glucose complexity during the course of critical illness: a pilot study

Godat, Emmanuel; Preiser, Jean‐Charles; Aude, Jean-Christophe; Kalfon, Pierre

doi:10.1007/s10877-019-00299-8

Cited by 1 publication

(1 citation statement)

References 58 publications

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“…1,2 Then we have got the consensus that glycemic fluctuation imposes much more harmful effects upon the outcomes than both hyperglycemia and hypoglycemia, 3,4 so as the variability of blood glucose. 5 Nevertheless, this seemingly unquestionable assertion had been doubted in some studies, 6 it was more commonly proven in the non-DM cohort but not in the DM. 7 Paul E Marik suggests that hyperglycemia and insulin resistance in the setting of acute illnesses is an evolutionarily preserved adaptive responsiveness to the disorder, which was believed to be a beneficial host response that enhances the host's chances of survival.…”

Section: Introductionmentioning

confidence: 99%

Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes

Lou

Jiang

Wang

et al. 2022

J Intensive Care Med

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Objectives Dysglycemia is associated with poor outcomes in critically ill patients,which is uncertain in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU upon the outcomes of critically ill patients with diabetes. Method Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was converted to A1C-derived average glucose (ADAG) by the equation: ADAG = [ (HbA1c * 28.7) – 46.7 ] * 18−1, blood glucose were measured four times a day during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3, 5, and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin, duration of renal replacement therapy(RRT), ventilator-free hours, and non-ICU days were also collected. Patients were divided into survival group and nonsurvival group according to survival or not at 28-day, the relationship between GAP and mortality were analyzed. Results 431 patients were divided into survival group and nonsurvival group. The two groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in the nonsurvival group. GAPmean-5 had the greatest predictive power with an AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%). Conclusion Glycemic GAP between the MGL within 5 days and ADAG was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of SOFA5.

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