Time in blood glucose range 70 to 180 mg/dL and survival rate in critically ill patients: A retrospective cohort study

Background While time in targeted blood glucose range (TIR) 70–140 mg/dL is a known factor associated with mortality in critically ill patients, it remains unclear whether TIR is associated with 28-day mortality under the glycemic control with a less tight target glucose range of 70–180 mg/dL. We aimed to examine whether TIR 70–180 mg/dL was associated with 28-day mortality. Methods This is a retrospective cohort study using data from a tertiary care center in Japan collected from January 2016 through October 2019. We included adult patients (aged ≥20 years) admitted to the ICU. We excluded patients 1) with diabetic ketoacidosis patients, 2) discharged within 48 hours, 3) with repeated ICU admissions. We calculated TIR 70–180 mg/dL using the measured blood glucose values (≥3 times per day). The primary outcome was 28-day mortality. We examined the association between TIR and 28-day mortality using a logistic regression and Cox proportional hazard models with a stratification by glycosylated hemoglobin (HbA1c) level of 6.5%. Additionally, we repeated the analyses using the TIR category to assess the optimal TIR. For the sensitivity analysis, we repeated the primary analysis using TIR during the first three days from ICU admission. Results Of 1,230 patients, the median age was 72 years, 65% were male, and 250 patients (20%) had HbA1c ≥6.5% on admission. In patients with HbA1c <6.5%, TIR <80% was associated with an increased risk of 28-day mortality, with an adjusted odds ratio (OR) of 1.88 (95%CI: 1.36–2.61). Likewise, when using 10% incremental TIR as a categorical variable, lower TIR was associated with a worse 28-day mortality compared with TIR ≥90% (e.g., adjusted OR of TIR <60%, 3.62 [95%CI 2.36–5.53]). Similar associations were found in the analyses using Cox proportional hazards model and using TIR during the first three days. By contrast, in patients with HbA1c ≥6.5%, there was no consistent association of TIR with 28-day mortality. Conclusions We found that lower TIR 70–180 mg/dL was associated with a higher 28-day mortality in critically ill patients with HbA1c <6.5%, whereas there was no consistent association in patients with HbA1c ≥6.5%.

Time in blood glucose range 70 to 180 mg/dL and survival rate in critically ill patients: A retrospective observational study

Objective: Time in targeted blood glucose range (TIR) 70-140 mg/dL has been associated with an increased risk of mortality in critically ill patients. Nevertheless, it remains unclear whether TIR is associated with 28-day mortality in critically ill patients under glycemic control with a less tight target glucose range of 70-180 mg/dL. We aimed to assess whether TIR 70-180 mg/dL was associated with 28-day mortality and to identify the optimal TIR. Design: A retrospective observational study. Setting: Data from a tertiary care centre in Japan, from 1 January 2016 through 31 October 2019. Participants: 1,230 adult patients admitted to the intensive care unit for more than three days. Outcome measure: The primary outcome was 28-day mortality. Results: Of 1,230 patients, patients with HbA1c ≥6.5% had a higher 28-day mortality than those with <6.5% (32.0% vs. 22.7%; p=0.003). In the multivariate logistic regression, TIR <80% was associated with an increased risk of 28-day mortality in patients with HbA1c <6.5% with an adjusted odds ratio (OR) of 1.88 (95% confidence interval [CI]: 1.36-2.61). When using 10% incremental TIR as a categorical variable, lower TIR was associated with worse 28-day mortality compared to TIR ≥90% in patients with HbA1c <6.5% (e.g., adjusted OR of TIR <60%, 3.62 [95%CI 2.36-5.53]). Similar associations were found in the analyses using the COX proportional hazards model. In addition, sensitivity analyses using TIR of the first three days showed that the overall associations were consistent with primary analyses. Conclusions: Our study demonstrated that lower TIR 70-180 mg/dL was associated with higher 28-day mortality in nondiabetic critically ill patients.

Predictive Value of Blood Glucose Range for Onset of Complications in Patients with Diabetes Mellitus Type 1

Background and aims: to develop a prognostic mathematical model for risk of microangiopathy in patients with diabetes mellitus type 1 (T1DM). Materials and methods: 62 T1DM patients were divided into 2 groups according to НвА1с level: group 1 (n=18) with НвА1с ≤ 7.0% and group 2 (n=44) with НвА1с > of 7.0%. HbA1c, Cpeptide, blood creatinine, estimated glomerular filtration rate (eGFR) CKD-EPI, first morning urinary albumin excretion (AU) were determined. Blood glucose levels were conducted by CGMS (Continuous Glucose Monitoring System). All patients were followed for 3 months. Rank correlation method was used. Results: We established the direct correlation between HbA1c the AU level ρ=0.29 (р<0.016) at the beginning and ρ=0.4 (р=0.021) after 3 months. AU level has a direct correlation with blood glucose range, at the beginning ρ=0.51 (р<0.001) and after 3 months ρ=0.48 (р=0.004) visits. We made the mathematical description of this dependence. Each additional unit of blood glucose range is accompanied by increasing an average level AU level by 0.4816 mg/l. Conclusion: our mathematical equation of dependence between AU level and blood glucose range gives the opportunities to predict diabetic kidney disease progression in T1DM patients.

Association of perioperative hyperglycemic state with postoperative infection

Background: Perioperative hyperglycemia is frequently encountered in clinical practice. Recent evidence suggests that hyperglycemia plays a significant role in the development of postoperative infections (POI). Major focus has been placed on whether hyperglycemia, as an independent risk factor, is associated with increased infection. The optimal targeted blood glucose range to prevent POI remains unclear, especially in the intra-operative period.Aims and Objectives: To study the association between peri-operative hyperglycemia to the subsequent risk of post-operative infections through a prospective observational study.Materials and Methods: A prospective study of 101 patients undergoing different types of general surgery procedures followed up to 30 days post-operatively was done. Random blood Sugar (RBS) was taken (1) Pre-operatively (2) Intra-operatively (3) Postoperatively- after 6, 24 and 48 hours. Primary end points of the study were (1) Surgical wound infection (2) Urinary tract infection (3) Septicemia.Results: Out of 101 patients 57 developed perioperative hyperglycemia (incidence- 56.4%). In normoglycemic group of patients infection rate was 4.5% (2/44) as compared to 26.3% (15/57) in perioperative hyperglycemic group.Conclusion: The present study provides a convincing evidence of an association between perioperative hyperglycemia and post-operative infection apart from giving a possible relationship between preoperative blood sugar levels and postoperative infection.Asian Journal of Medical Sciences Vol.7(6) 2016 32-35