Prevalence and Impact of Unknown Diabetes in the ICU

Carpenter, David; Gregg, Sara; Xu, Kejun; Buchman, Timothy G.; Coopersmith, Craig M.

doi:10.1097/ccm.0000000000001353

Cited by 55 publications

(47 citation statements)

References 43 publications

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“…Because inpatient insulin use (5) and discharge orders (6) can be more effective if based on an A1C level on admission (7), perform an A1C test on all patients with diabetes or hyperglycemia admitted to the hospital if the test has not been performed in the prior 3 months. In addition, diabetes self-management knowledge and behaviors should be assessed on admission and diabetes self-management education (DSME) should be provided, if appropriate.…”

Section: Considerations On Admissionmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Section: Considerations On Admissionmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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“…Previous epidemiological studies report the prevalence of unknown diabetes to be between 5 and 10% of patients admitted to ICU [2, 28]. To limit the likelihood of unknown diabetes being a major confounder prevalent diabetes was identified by a thorough process including verifying across two separate databases (using ICD-10 codes and NDSS registration) and excluding patients with a blood glucose > 20 mmol/L (360 mg/dL), or who registered with the NDSS within 30 days of hospital discharge, were excluded [16].…”

Section: Discussionmentioning

confidence: 99%

Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness

et al. 2016

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ObjectiveStress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness.DesignRetrospective cohort study.SettingAll adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011.PatientsStress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression.Main ResultsStress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness.ConclusionsStress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.

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“…44 Patients with an unknown diagnosis of diabetes at the time of critical illness (HbA1c > 6.5%, without history of diabetes) have been identified as not only having significantly worse dysglycemia but also an increased mortality risk (13.8 vs. 11.4%; p ¼ 0.01) compared with those without diabetes. 69 It is not only the history of diabetes (diagnosed or undiagnosed) but also the metabolic control prior to critical illness that seems to affect outcomes in the ICU. In a critically ill cohort, Plummer and colleagues 6 showed that in patients with DM and very good (HbA1c < 6%) and adequate prior metabolic control (HbA1c between 6 and 7%), an increase in peak BG in the first 48 hours of critical illness was associated with increased mortality, whereas patients with poor baseline control tolerated higher peak BG better.…”

Section: Role Of Pre-existing Diabetes Mellitusmentioning

confidence: 99%

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

Tickoo

2019

Semin Respir Crit Care Med

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In the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

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Prevalence and Impact of Unknown Diabetes in the ICU

Abstract: Patients with unknown diabetes represent a significant percentage of ICU admissions. Measurement of hemoglobin A1c at admission can prospectively identify a population that are not known to have diabetes but have significant challenges in glycemic control in the ICU.

Cited by 55 publications

References 43 publications

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

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