Details
Category: Volume 05 Issue 07 July 2017
Hits: 1167

Title: Glycaemic variability and Mortality in critically ill patients

Authors: Rajashree Khot MD, DNB (Medicine), Prasad Gaikwad, MD (Medicine), Rakhee Joshi, MD (Medicine)

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.239

Abstract

Background

Critical illness is still a major part of burden on healthcare systems and comprises about 7.6% of total in-hospital admissions1. Critically ill patients have different glucose metabolism due to stress related conditions, an entity labeled as stress hyperglycemia which is mainly attributed to release of counter regulatory hormones2,3. Stress hyperglycemia is found in both diabetic as well as non-diabetics moreover in non- diabetics4. Fasting blood sugar, postprandial blood sugar, HbA1c are important predictors of glycemic control. But these have limitations in critical set up and thus there is one more entity beyond these traditional markers i. e. glycemic variability (GV)3 which may be an important predictor of outcome in critically ill patients.

References

  1. Kahn JM, Le T, Angus DC, et al. The epidemiology of chronic critical illness in the United States. Crit Care Med 2015 Mar; 43(2):282–7.
  2. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin. 2001 Jan; 17(1):107-24.
  3. Kota S, Modi K, Satya Krishna S. Glycemic variability: Clinical implicate-ons. Indian J Endocr Met. 2013; 17(4):611
  4. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003; 78(12):1471-8.
  5. Raz I, Wilson PW, Strojek K, et al. Effects of prandial versus fasting glycemia on cardiovascular outcomes in type 2 diabetes: The HEART 2D trial. Diabetes Care 2009; 32:381-6.
  6. Hirsch IB, Brownlee M. Should minimal blood glucose variability become the gold standard of glycemic control? J Diabetes Complications. 2005; 19(3):178–81.
  7. Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med 2008; 36:3008–13.
  8. Egi M, Bellomo R, Stachowski E, et al. Blood glucose concentration and outcome of critical illness: the impact of diabetes. Crit Care Med. 2008; 36(8):2249-55.
  9. Todi S, Bhattacharya M. Glycemic variability and outcome in critically ill. Indian J Crit Care Med. 2014; 18(November):285–90.
  10. Muggeo M, Zoppini G, Bonora E, et al. Fasting plasma glucose variability predicts 10-year survival of type 2 diabetic patients: the Verona Diabetes Study. Diabetes Care. 2000; 23(1):45–50.
  11. Zhang J-W, He L-J, Cao S-J, et al. Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions. Diabetol Metab Syndr. 2014; 6(1):76.
  12. Su G, Mi S, Tao H, Li Z, et al. Impact of admission glycemic variability, glucose, and glycosylated hemoglobin on major adverse cardiac events after acute myocardial infarction. Diabetes Care. 2013; 36(4):1026–32.
  13. Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med 2008; 36:3008–13.
  14. Ali NA, O’Brien JM Jr, Dungan K, et al. Glucose variability and mortality in patients with sepsis. Crit Care Med. 2008; 36(8): 2316–21.

Corresponding Author

Dr Rajashree Khot

Plot no.52Jayneeta, New Ramdaspeth, Nagpur -440010, India

Phone No.+919823134598, Fax- 91-712-2426307, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.