Effect of Diabetes Mellitus on Outcomes of Hyperglycemia in a Mixed Medical Surgical Intensive Care Unit

Abstract

The results showed that a diagnosis of diabetes was not an independent predictor of mortality, and that diabetic patients who were uncontrolled did not have worse outcomes. Diabetic nonsurvivors were associated with a greater amount of hypoglycemic episodes, suggesting these patients may benefit from a more lenient blood glucose protocol.

Effects of Hyperglycemia and Continuous Intravenous Insulin on Outcomes of Surgical Patients

“…We have previously shown that patients with a history of diabetes mellitus whose blood glucose was poorly controlled were not associated with an increased mortality; however, these patients demonstrated a significant intolerance to hypoglycemia. Diabetic patients with only one episode of a blood glucose <60 mg/dL were associated with a significant increase in adjusted mortality [8]. This finding may be associated with non-biologic reasons previously published, to include more attentive care by providers, appropriate treatment of other comorbidities, healthier life style recommendations provided by counseling as an outpatient, and potentially earlier admission to the hospital [7].…”

“…There have been previous studies describing diabetes as a risk modifier during acute illness, where hyperglycemia in these patients may have a different biological and/or clinical implication, possibly due to the chronic nature of their disease and the ability to adapt to episodes of significant and sometimes long term hyperglycemia [7,8,27]. We have previously shown that patients with a history of diabetes mellitus whose blood glucose was poorly controlled were not associated with an increased mortality; however, these patients demonstrated a significant intolerance to hypoglycemia.…”

“…However, trauma patients demonstrated a trend towards improved outcomes with intensive control, without a difference in operative versus nonoperative patients [5]. More recently, research has been directed at identifying specific patient populations who may or may not benefit from IIT [6][7][8].…”

Biochemistry in Intensive Care

“…There is some further interest in continuous glucose monitoring and, with better technology, options for this interesting development appear to be emerging [75]. Recent work suggests that diabetes mellitus does not increase mortality but may indeed improve outcome from a critical illness, thus confounding further the issue of the potential benefit from IIT [76].…”

“…Blood or serum lactate measurements are of comparative specific value in the management of conditions such as congenital organic acidaemias, some toxic states (e.g. alcohols), although there can be analytical interference with some alcohols and POCT lactate measurements [76], as well as some infective conditions, most notably severe falciparum malaria [78][79][80]. Nevertheless, most of these acidotic states with multiple organ failure are accompanied by increased unmeasured anions that may be quantified using a calculation of the strong ion gap (SIG) [81].…”