Michael J Lanspa1, James S Krinsley2, Andrew M Hersh3, Emily L Wilson4, John R Holmen5, James F Orme6, Alan H Morris6, Eliotte L Hirshberg7. 1. Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT. Electronic address: michael.lanspa@imail.org. 2. Division of Critical Care, Department of Medicine, Stamford Hospital, Columbia Vagelos University College of Physicians and Surgeons, New York, NY. 3. Department of Pulmonary and Critical Care Medicine, San Antonio Military Medical Center, San Antonio, TX. 4. Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT. 5. Homer Warner Center, Intermountain Healthcare, Murray, UT. 6. Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT. 7. Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Abstract
BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, reduced time in targeted blood glucose range (TIR) is associated with increased risk of death in critically ill patients. This relation between TIR and mortality may be confounded by diabetic status and antecedent glycemic control. METHODS: This study retrospectively analyzed critically ill patients managed with the same IV insulin protocol at multiple centers. The percentage of TIR between 70 and 139 mg/dL was calculated. Patients with diabetic ketoacidosis, patients who had < 10 blood glucose readings, and patients with repeat admissions were excluded. The highest recorded glycosylated hemoglobin value in the preceding 3 months or up to 1 month following admission were used as a surrogate for the patient's preexisting glucose control. Stratified regression analyses were performed for 30-day mortality, with covariates of age, sex, TIR ≥ 80%, Acute Physiology Score, and Charlson Comorbidity Index. RESULTS: A total of 9,028 patients, 53.2% of whom had diabetes, were studied. Median TIR was 84.1% for nondiabetic patients and 64.5% for patients with diabetes. Mortality was lower in those with TIR > 80% compared with those with TIR ≤ 80% (12.4% vs 19.2%; P < .001). TIR > 80% was independently associated with reduced mortality in nondiabetic patients (OR, 0.52; P < .001), patients with diabetes (OR, 0.69; P = .001), and patients with well-controlled disease (OR, 0.50; P < .001) but not in patients with poorly controlled disease (OR, 0.86; P = .40). CONCLUSIONS: TIR was independently associated with mortality in critically ill patients, particularly those with good antecedent glucose control.
BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, reduced time in targeted blood glucose range (TIR) is associated with increased risk of death in critically illpatients. This relation between TIR and mortality may be confounded by diabetic status and antecedent glycemic control. METHODS: This study retrospectively analyzed critically illpatients managed with the same IV insulin protocol at multiple centers. The percentage of TIR between 70 and 139 mg/dL was calculated. Patients with diabetic ketoacidosis, patients who had < 10 blood glucose readings, and patients with repeat admissions were excluded. The highest recorded glycosylated hemoglobin value in the preceding 3 months or up to 1 month following admission were used as a surrogate for the patient's preexisting glucose control. Stratified regression analyses were performed for 30-day mortality, with covariates of age, sex, TIR ≥ 80%, Acute Physiology Score, and Charlson Comorbidity Index. RESULTS: A total of 9,028 patients, 53.2% of whom had diabetes, were studied. Median TIR was 84.1% for nondiabeticpatients and 64.5% for patients with diabetes. Mortality was lower in those with TIR > 80% compared with those with TIR ≤ 80% (12.4% vs 19.2%; P < .001). TIR > 80% was independently associated with reduced mortality in nondiabeticpatients (OR, 0.52; P < .001), patients with diabetes (OR, 0.69; P = .001), and patients with well-controlled disease (OR, 0.50; P < .001) but not in patients with poorly controlled disease (OR, 0.86; P = .40). CONCLUSIONS: TIR was independently associated with mortality in critically illpatients, particularly those with good antecedent glucose control.
Authors: Athirah Abdul Razak; Asma Abu-Samah; Normy Norfiza Abdul Razak; Ummu Jamaludin; Fatanah Suhaimi; Azrina Ralib; Mohd Basri Mat Nor; Christopher Pretty; Jennifer Laura Knopp; James Geoffrey Chase Journal: Med Devices (Auckl) Date: 2020-06-04