Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia

Abstract

Background Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV. Methods This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible. Results Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P < 0.01), and by a factor of 1.42 (1.04 to 1.97) in patients treated with GCs but without T2DM during the daytime (P = 0.031) compared to patients without T2DM and not treated with GCs. CV (95%CI) increased by 5.1 (0.0 to 10.1) and 8.1 (1.0 to 15.2) percentage points during the daytime and the nighttime, respectively, in patients with T2DM and not treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.046 and P = 0.026, respectively). PPGE (95% CI) increased during lunch by 2.5 (0.7 to 4.3) mmol/L (45 (13 to 77) mg/dL) in patients with T2DM and treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.018). Conclusions CAP patients receiving GCs, especially those with T2DM, are at great risk of developing high GV and therefore require clinical attention to mitigate GV. This applies particularly during the daytime. Results support the 1 to 2-h post-lunch screening procedure for glucocorticoid-induced hyperglycemia in patients without diabetes. SD was positively correlated with hospital length of stay.

A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials

“…40,41 Most studies measuring GV in hospitalized patients using CGM have used all available sensor data values throughout the stay. [42][43][44][45] Several studies in critically ill and non-critically ill hospitalized patients have shown the independent association between high GV and poor clinical outcomes. [35][36][37]42,43,45,46,47 Although studies assessing GV have usually included all value points during hospital stay, evaluation of daily data on hospitalized patients may provide sufficient information to make therapeutic changes when needed.…”

“…[42][43][44][45] Several studies in critically ill and non-critically ill hospitalized patients have shown the independent association between high GV and poor clinical outcomes. [35][36][37]42,43,45,46,47 Although studies assessing GV have usually included all value points during hospital stay, evaluation of daily data on hospitalized patients may provide sufficient information to make therapeutic changes when needed. Though multiple metrics have been suggested to measure GV, CV, and SD are the most commonly reported.…”

WACPN: A Neural Network for Pneumonia Diagnosis

“…Community-acquired pneumonia (CAP) is considered a sort of pneumonia [ 1 ] developed outside hospitals, and clinics, along with infirmaries [ 2 ]. CAP may affect people of any age, but it is more prevalent in very young and elderly groups, which may need hospital treatment if they develop CAP [ 3 ]. Chest computed tomography (CCT) is a crucial way to help radiologists/physicians to diagnose CAP patients.…”

Clinical characteristics and pathogen analysis of bronchoalveolar lavage fluid in elderly patients with community‐acquired pneumonia

“…1 Many literatures show that CAP has a high incidence and hospitalization rate (11‰ and 4‰, respectively) and is more likely to recurrence. [2][3][4][5] With the medical interventions level gets more and more advanced and the treatment methods are constantly developing, however, the mortality rate of this disease has not decreased significantly. 6 Population aging is a problem for countries all over the world.…”

“…Developing countries bear a significant brunt of the disease, impacting healthcare 1 . Many literatures show that CAP has a high incidence and hospitalization rate (11‰ and 4‰, respectively) and is more likely to recurrence 2–5 . With the medical interventions level gets more and more advanced and the treatment methods are constantly developing, however, the mortality rate of this disease has not decreased significantly 6 …”