Glycated hemoglobin at admission in the intensive care unit: Clinical implications and prognostic relevance

Kompoti, Maria; Michalia, Martha; Salma, Vaia; Diogou, Evangelia; Lakoumenta, Anthi; Clouva-Molyvdas, Phyllis-Maria

doi:10.1016/j.jcrc.2014.08.014

Cited by 27 publications

(22 citation statements)

References 20 publications

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“…None of the studies measured HbA1c on admission for the majority of patients. HbA1c is a validated tool for the diagnosis of previously unrecognised diabetes in hospitalised and critically ill patients [ 46 – 48 ], and consensus guidelines now recommend the measurement of HbA1c in all hospitalised patients with hyperglycaemia [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis

et al. 2016

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BackgroundHyperglycaemia occurs frequently in critically ill patients without diabetes. We conducted a systematic review and meta-analysis to evaluate whether this ‘stress hyperglycaemia’ identifies survivors of critical illness at increased risk of subsequently developing diabetes.MethodsWe searched the MEDLINE and Embase databases from their inception to February 2016. We included observational studies evaluating adults admitted to the intensive care unit (ICU) who developed stress hyperglycaemia if the researchers reported incident diabetes or prediabetes diagnosed ≥3 months after hospital discharge. Two reviewers independently screened the titles and abstracts of identified studies and evaluated the full text of relevant studies. Data were extracted using pre-defined data fields, and risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled ORs with 95 % CIs for the occurrence of diabetes were calculated using a random-effects model.ResultsFour cohort studies provided 2923 participants, including 698 with stress hyperglycaemia and 131 cases of newly diagnosed diabetes. Stress hyperglycaemia was associated with increased risk of incident diabetes (OR 3.48; 95 % CI 2.02–5.98; I2 = 36.5 %). Studies differed with regard to definitions of stress hyperglycaemia, follow-up and cohorts studied.ConclusionsStress hyperglycaemia during ICU admission is associated with increased risk of incident diabetes. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1471-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis

et al. 2016

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“…showed that a cutoff of 6.5% for HA1c could predicte higher ICU mortality in patients without prior history of diabetes; but, in patients with prior history of diabetes a cutoff of 7 for HbA1c had no association with ICU mortality. [ 32 ] The possible mechanisms explaining the effects of HbA 1 c variability on outcomes might be as followings: Low socioeconomic status which might indicate a suboptimal management of diabetes, insulin resistance, which in itself has been implicated in the pathogenesis of diabetes complications,[ 33 ] and homeostatic imbalance; for example, through intracellular sorbitol accumulation. [ 34 ] Previous studies suggest that increased HbA 1 c levels are a negative prognostic marker in DM patients admitted to ICUs.…”

Section: Discussionmentioning

confidence: 99%

Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

Mahmoodpoor

Hamishehkar

Shadvar

et al. 2016

Indian Journal of Critical Care Medicine

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Background and Aims:The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM). In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU) admission blood glucose and glucose control during ICU stay with mortality in critically ill patients.Materials and Methods:Five hundred patients admitted to two ICUs were enrolled. Blood sugar and hemoglobin A1c (HbA1c) concentrations on ICU admission were measured. Age, sex, history of DM, comorbidities, Acute Physiology and Chronic Health Evaluation II score, sequential organ failure assessment score, hypoglycemic episodes, drug history, mortality, and development of acute kidney injury and liver failure were noted for all patients.Results:Without considering the history of diabetes, nonsurvivors had significantly higher HbA1c values compared to survivors (7.25 ± 1.87 vs. 6.05 ± 1.22, respectively, P < 0.001). Blood glucose levels in ICU admission showed a significant correlation with risk of death (P < 0.006, confidence interval [CI]: 1.004–1.02, relative risk [RR]: 1.01). Logistic regression analysis revealed that HbA1c increased the risk of death; with each increase in HbA1c level, the risk of death doubled. However, this relationship was not statistically significant (P: 0.161, CI: 0.933–1.58, RR: 1.2).Conclusions:Acute hyperglycemia significantly affects mortality in the critically ill patients; this relation is also influenced by chronic hyperglycemia.

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“…[CVD]) (8,9) may help differentiate people with previously undiagnosed diabetes and dysglycemia from those with stress-induced hyperglycemia and provides an opportunity to diagnose and initiate diabetes therapies (10)(11)(12)(13). Among people admitted to an intensive care unit (ICU), an A1C drawn at admission allows identification of people with previously unknown diabetes, people at risk of glycemic management challenges and people at an increased risk of mortality (14,15). A1C has been found to be specific for diagnosis of diabetes in the hospital setting, although not as sensitive as in the outpatient setting (13,16).…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Management of Diabetes

Malcolm¹,

Halperin²,

Miller³

et al. 2018

Canadian Journal of Diabetes

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is common in hospitalized people, even among those without a previous history of diabetes, and is associated with increased in-hospital complications, longer length of stay and mortality. • Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A proactive approach to glycemic management using scheduled basal, bolus and correction (supplemental) insulin is the preferred method. The use of correction-only (supplemental) insulin, which treats hyperglycemia only after it has occurred, should be discouraged as the sole modality for treating elevated blood glucose levels. • For the majority of noncritically ill hospitalized people with diabetes, preprandial blood glucose targets should be 5.0 to 8.0 mmol/L, in conjunction with random blood glucose values <10.0 mmol/L, as long as these targets can be safely achieved. For critically ill hospitalized people with diabetes, blood glucose levels should be maintained between 6.0 and 10.0 mmol/L. • Hypoglycemia is a major barrier to achieving targeted glycemic control in the hospital setting. Health-care institutions should develop protocols for the assessment and treatment of hypoglycemia. KEY MESSAGES FOR PEOPLE WITH DIABETES • If your admission to hospital is planned, talk with your health-care providers (e.g. surgeon, anesthetist, primary care provider, diabetes health provider, etc.) before you are admitted in order to develop an in-hospital diabetes care plan that addresses such issues as: • Who will manage your diabetes in the hospital? • Will you be able to self-manage your diabetes? • What adjustments to your diabetes medications or insulin doses may be necessary before and after medical procedures or surgery? • If you use an insulin pump, are hospital staff familiar with pump therapy? • Your blood glucose levels may be higher in hospital than your usual target range due to a variety of factors, including the stress of your illness, medications, medical procedures and infections. • Your diabetes medications may need to be changed during your hospital stay to manage the changes in blood glucose, or if medical conditions develop that make some medications no longer safe to use. • When you are discharged, make sure that you have written instructions about: • Changes in your dosage of medications or insulin injections or any new medications or treatments • How often to check your blood glucose • Who to contact if you have difficulty managing your blood glucose levels. Screening for and Diagnosis of Diabetes and Hyperglycemia in the Hospital Setting A history of diabetes should be elicited in all patients admitted to hospital and, if present, should be clearly identified on the medical record. In view of the high prevalence of inpatient hyperglycemia with associated poor outcomes, an admission BG measurement of all patients would help identify people with diabetes, even in the absence of a prior diagnosis (1,5). In-hospital hyperglycemia is defined as any glucose value >7.8 mmol/L. For hospitalized people with known diabetes,...

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Glycated hemoglobin at admission in the intensive care unit: Clinical implications and prognostic relevance

Cited by 27 publications

References 20 publications

Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis

Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis

Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

In-Hospital Management of Diabetes

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