Usefulness of the plasma glucose concentration-to-HbA1c ratio in predicting clinical outcomes during acute illness with extreme hyperglycaemia

Su, Yu Wen; Hsu, Chien Yi; Guo, Ying; Chen, H. S.

doi:10.1016/j.diabet.2016.07.036

Cited by 44 publications

(61 citation statements)

References 29 publications

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“…Baseline characteristics were analyzed by x 2 statistics for the categorical variables and Kruskal-Wallis test for the continuous variables. The glucose/HbA1c ratio was calculated by fasting blood glucose (mmol/L) divided by HbA1c (%) (6). The associations between glucose/HbA1c ratio and neurological deficit were analyzed by using logistic regression model, and the Cox proportional-hazards model was used for analyzing the association with mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike absolutely hyperglycemia, relative measures of hyperglycemia, such as glucose/ HbA1c ratio, reflected the relative acute rapid increase of blood glucose level compared with premorbid glucose status. Previous study showed that such relative measures controlling for background glycemia better predicted prognosis of critical illness than absolute hyperglycemia (6)(7)(8). We previously found that glucose/HbA1c ratio was related to allcause death in people with acute ischemic stroke (9).…”

Section: Discussionmentioning

confidence: 99%

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Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes

Quan

Wang

et al. 2020

Front. Neurol.

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Objective: To determine the relationship between stress hyperglycemia and prognosis of acute ischemic stroke people with and without diabetes. Methods: A subgroup of 8,622 acute ischemic stroke people with baseline levels of fasting blood glucose and HbA1c from the China National Stroke Registry II were analyzed. Stress hyperglycemia was measured by glucose/glycated hemoglobin (HbA1c) ratio, calculated by fasting blood glucose divided by HbA1c. Diabetes was diagnosed according to medical history or a HbA1c level of ≥6.5%. The outcomes included severe neurological deficit defined as modified Rankin Scale score of 3 to 5 and all-cause death at 1 year. The associations between glucose/HbA1c ratio and neurological deficit and all-cause death were analyzed via logistic regression model and Cox proportional-hazards model, respectively. Subgroup analyses of participants with or without diabetes were performed separately. Results: Totally 1,189 (13.7%) participants had severe neurological deficit, and 678 (7.9%) died within 1 year. Compared with the lowest quartile, the highest quartiles of glucose/HbA1c ratio were associated with elevated risk of worse neurological deficit (20.1% vs. 13.0%; adjusted OR, 1.83; 95%CI, 1.31-2.54, p = 0.001), and mortality (12.1% vs. 6.6%; adjusted HR, 2.04; 95% CI, 1.47-2.83, p < 0.0001) after adjusted for potential covariates. The association of glucose/HbA1c ratio with neurological deficit remained in the participants with and without diabetes, while it was only significant in the participants without diabetes as for the outcome of mortality. Conclusions: Stress hyperglycemia, measured by glucose/HbA1c ratio, was associated with increased risk of severe neurological deficit and mortality within 1 year in the acute ischemic stroke people.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes

Quan

Wang

et al. 2020

Front. Neurol.

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“…Others have reported that relative hyperglycemia at admission to hospital has been associated with poor outcomes in patients with acute illness [ 10 ], stroke [ 9 ], acute myocardial infarction [ 30 , 32 ] and in cardiogenic shock [ 33 ]. In addition to SHR two other measures of relative glycemia have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the association between relative glycemia and critical illness was present in patients with and without background hyperglycemia. Since this publication, several other studies have reported that relative glycemia at hospital admission predicts outcomes for patients admitted to hospital with a stroke [ 9 ], acute illness [ 10 ], acutely ill requiring intensive care unit (ICU) admission [ 11 ] and after percutaneous coronary intervention [ 12 ]. These studies demonstrate that quantifying relative hyperglycemia at admission to hospital provides important prognostic information in patients with and without diabetes.…”

Section: Introductionmentioning

confidence: 99%

Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data

Lee

Burt

Heilbronn

et al. 2017

Cardiovasc Diabetol

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BackgroundHyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). We evaluated whether complications after AMI are associated with absolute or relative glycemia.MethodsA total of 192 patients with AMI were randomized to intensive or conventional insulin therapy. Absolute glycemia was defined as mean blood glucose level (BGL) during the first 24 h following randomization. Relative glycemia was defined by the stress hyperglycaemia ratio (SHR), calculated as mean BGL divided by average glucose concentration over the prior 3 months estimated from glycosylated haemoglobin. The primary endpoint was a “complicated AMI”, defined as an AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac arrest, reinfarction, cardiogenic shock, inotrope use or emergency revascularization.ResultsThere was not a significant association between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L glucose increment, 95% confidence intervals (CI) 0.93–1.19). In contrast, SHR was positively associated with a complicated myocardial infarction (OR 1.22 per 0.1 SHR increment, 95% CI 1.06–1.42), and individual complications of death (OR 1.55, 95% CI 1.14–2.11), congestive cardiac failure (OR 1.27, 95% CI 1.05–1.54), arrhythmia (OR 1.31, 95% CI 1.12–1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03–1.97). The relationship between SHR and a complicated AMI was independent of diabetic status, intensive insulin therapy, sex and hypoglycemia.ConclusionsRelative, but not absolute, glycemia during insulin treatment is independently associated with complications after an AMI. Future studies should investigate whether basing therapeutic glycaemic targets on relative glycemia improves patient outcomes.

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“…The specific and more relevant role of acute hyperglycemia in diabetes, more than the previous HbA1c, is well known in the Intensive Care Units (ICU), where an increased gap between admission glucose and HbA1 has been found as predictor of mortality in critically ill patients with diabetes [7,8]. The impact of acute (stress) hyperglycemia and glucose variability in critically ill patients is very well known [9].…”

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confidence: 99%

Hyperglycemia and COVID-19: What was known and what is really new?

Ceriello

2020

Diabetes Research and Clinical Practice

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Usefulness of the plasma glucose concentration-to-HbA1c ratio in predicting clinical outcomes during acute illness with extreme hyperglycaemia

Cited by 44 publications

References 29 publications

Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes

Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes

Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data

Hyperglycemia and COVID-19: What was known and what is really new?

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