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The classification of hospitalized patients with hyperglycemia and its implication on outcome: results from a prospective observational study in Internal Medicine

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Abstract

The relevance of classifying hyperglycemic hospitalized subjects (HS) as known diabetes (D), newly discovered diabetes (ND), and stress hyperglycemia (SH) is unclear. The aim of this study was to determine the prevalence, in-hospital mortality, and length of stay (LOS) of three different phenotypes of HS. Fasting glucose ≥126 mg/dL (7 mmol/L) or random blood glucose ≥200 mg/dL (11.1 mmol/L) defined HS who were categorized into three groups: D; ND (no history of diabetes and HbA1c ≥48 mmol/mol); SH (no history of diabetes and HbA1c <48 mmol/mol). The end points of the study were in-hospital mortality and LOS. Of 1447 consecutive enrolled subjects, the prevalence of HS was 28.6 % (415/1447), of these 71.6 % had D, 21.2 % SH, and 7.2 % ND, respectively. In-hospital death was 3.9 % in normoglycemic and 6.0 % in hyperglycemic subjects. Individuals with SH had an increased risk of in-hospital death (7.9 %) (HR 2.17, 95 % CI 1.18–4.9; p = 0.039), while this was not observed for D and ND patients. The mean LOS was greater in ND and SH subjects. Hyperglycemia is common, and is associated with an increased risk of in-hospital mortality and extension of hospital stay. HbA1c along with clinical history is a useful tool to identify subgroups of hyperglycemic hospitalized subjects. Individuals with SH have a longer LOS, and a double risk of in-hospital mortality. Additionally, identifying previously unknown diabetes represents a remarkable opportunity for prevention of diabetes-related acute and chronic complications.

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References

  1. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE, American Association of Clinical Endocrinologists, American Diabetes Association (2009) American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control. Diabetes Care 32:1119–1131

  2. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE (2002) Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982

    Article  CAS  PubMed  Google Scholar 

  3. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC (2001) Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32:2426–2432

    Article  CAS  PubMed  Google Scholar 

  4. Chen PC, Chua SK, Hung HF, Huang CY, Lin CM, Lai SM, Chen YL, Cheng JJ, Chiu CZ, Lee SH, Lo HM, Shyu KG (2014) Admission hyperglycemia predicts poorer short- and long-term outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction. J Diabetes Investig 5:80–86

    Article  PubMed  Google Scholar 

  5. Bochicchio GV, Sung J, Joshi M, Bochicchio K, Johnson SB, Meyer W, Scalea TM (2005) Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 58:921–924

    Article  PubMed  Google Scholar 

  6. Gabbanelli V, Pantanetti S, Donati A, Principi T, Pelaia P (2005) Correlation between hyperglycemia and mortality in a medical and surgical intensive care unit. Minerva Anestesiol 71:717–725

    CAS  PubMed  Google Scholar 

  7. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, Raskin P, American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism (2008) Hyperglycemia and acute coronary syndrome: a scientific statement from the American heart association diabetes committee of the council on nutrition, physical activity, and metabolism. Circulation 117:1610–1619

  8. Pres D, Gasior M, Strojek K, Gierlotka M, Hawranek M, Lekston A, Wilczek K, Tajstra M, Gumprecht J, Poloński L (2010) Blood glucose level on admission determines in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock treated with percutaneous coronary intervention. Kardiol Pol 68:743–751

    PubMed  Google Scholar 

  9. Lazzeri C, Valente S, Gensini GF (2014) Hyperglycemia in acute heart failure: an opportunity to intervene? Curr Heart Fail Rep 11:241–245

    Article  CAS  PubMed  Google Scholar 

  10. Capes SE, Hunt D, Malmberg K, Gerstein HC (2000) Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 355:773–778

    Article  CAS  PubMed  Google Scholar 

  11. Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM (2005) Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 111:3078–3086

    Article  CAS  PubMed  Google Scholar 

  12. Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML (2009) Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 37:3001–3009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW (2006) Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 61:284–289

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB, American Diabetes Association Diabetes in Hospitals Writing Committee (2004) Management of diabetes and hyperglycemia in hospitals. Diabetes Care 27:553–591

  15. McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ (2005) The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care 28:810–815

    Article  PubMed  Google Scholar 

  16. McAlister FA, ManJ Bistritz L, AmadH Tandon P (2003) Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes. Diabetes Care 26:1518–1524

    Article  PubMed  Google Scholar 

  17. Pomposelli JJ, Baxter JK 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, Bistrian BR (1998) Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr 22:77–81

    Article  CAS  PubMed  Google Scholar 

  18. Burt MG, Roberts GW, Aguilar-Loza NR, Quinn SJ, Frith PA, Stranks SN (2013) Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease. Intern Med J 43:721–724

    Article  CAS  PubMed  Google Scholar 

  19. Rapi S, Salti S, Peruzzi B, Veroni F (2014) Point-of-care testing (POCT) networks: verification of glucose meter (accucheck inform II) performance by a quality assessment program managed by the central laboratory. J Near-Patient Test Technol 13(1):18–20

    Google Scholar 

  20. Morgan RJM, Williams F, Wright MM (1997) An early warning scoring system for detecting developing critical illness. Clin Intensive Care 8:100

    Google Scholar 

  21. Subbe CP, Kruger M, Gemmel L (2001) Validation of a modified early warning score in medical admissions. Q J Med 94:521–526

    Article  CAS  Google Scholar 

  22. American Diabetes Association (2014) Standards of medical care in diabetes—2014. Diabetes Care 37:14–80

    Article  Google Scholar 

  23. Inzucchi SE (2006) Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med 355:1903–1911

    Article  CAS  PubMed  Google Scholar 

  24. http://ars.toscana.it/. Accessed 15 Dec 2014

  25. Goldberg PA, Roussel MG, Inzucchi SE (2005) Clinical results of an updated insulin infusion protocol in critically ill patients. Diabetes Spectr 18:188–191

    Article  Google Scholar 

  26. Ku SY, Sayre CA, Hirsch IB, Kelly JL (2005) New insulin infusion protocol improves blood glucose control in hospitalized patients without increasing hypoglycemia. Jt Comm J Qual Patient Saf 31:141–147

    PubMed  Google Scholar 

  27. Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenström A, Wedel H, Welin L (1995) Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI Study): effects on mortality at 1 year. J Am Coll Cardiol 26:57–65

    Article  CAS  PubMed  Google Scholar 

  28. Moghissi ES, Hirsch IB (2005) Hospital management of diabetes. Endocrinol Metab Clin North Am 34:99–116

    Article  PubMed  Google Scholar 

  29. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A (2003) Continuous Insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021

    Article  CAS  PubMed  Google Scholar 

  30. Markovitz LJ, Wiechmann RJ, Harris N, Hayden V, Cooper J, Johnson G, Harelstad R, Calkins L, Braithwaite SS (2002) Description and evaluation of a glycemic management protocol for patients with diabetes undergoing heart surgery. Endocr Pract 8:10–18

    Article  PubMed  Google Scholar 

  31. Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, Lee SL, Dziura JD, Inzucchi SE (2004) Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care 27:461–467

    Article  CAS  PubMed  Google Scholar 

  32. Meijering S, Corsjens A, Tulleken JE, Meertens JHJM, Zijlstra JG, Ligtenberg JM (2006) Towards a feasible algorithm for tight glycaemic control in critically ill patients: a systematic review of the literature. Crit Care 10:R19

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hirsch IB (2005) Insulin analogues. N Engl J Med 352:174–183

    Article  CAS  PubMed  Google Scholar 

  34. Riddle MC (2005) Glycemic management of type 2 diabetes: an emerging strategy with oral agents, insulin, and combinations. Endocrinol Metab Clin North Am 34:77–98

    Article  CAS  PubMed  Google Scholar 

  35. Edelman SV, Morello CM (2005) Strategies for insulin therapy in type 2 diabetes. South Med J 98:363–371

    Article  PubMed  Google Scholar 

  36. Gulli G, Frasson S, Borzì V, Fontanella A, Grandi M, Marengo C, Nicolucci A, Pastorelli R, Solerte B, Gatti A, Raimondo FC, Bonizzoni E, Gussoni G, Mazzone A, Ceriello A (2014) Effectiveness of an educational intervention on the management of type 2 diabetic patients hospitalized in internal medicine: results from the FADOI-DIAMOND study. Acta Diabetol 51:765–770

    Article  PubMed  Google Scholar 

  37. Wright RJ, Frier BM (2008) Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev 24:353–363

    Article  CAS  PubMed  Google Scholar 

  38. Hirsch IB (2012) Understanding low sugar from NICE-SUGAR. N Engl J Med 367:1150–1152

    Article  CAS  PubMed  Google Scholar 

  39. Malhotra A (2006) Intensive insulin in intensive care. N Engl J Med 354:516–518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Umpierrez GE, Kosiborod M (2014) Inpatient dysglycemia and clinical outcomes: association or causation? J Diabetes Complicat 28:427–429

    Article  PubMed  Google Scholar 

  41. Kosiborod M, Inzucchi SE, Goyal A, Krumholtz HM, Masoudi FA, Xiao L, Spertus JA (2009) Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA 301:1556–1564

  42. Greci LS, Kailasam M, Malkani S, Katz DL, Hulinsky I, Ahmadi R, Nawaz H (2003) Utility of HbA1c levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes Care 26:1064–1068

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to all patients participating in the study and to the medical and nursing staff providing continuous care and assistance. The authors also wish to thank Jamie Linda Morris for the language editing of the manuscript.

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Authors and Affiliations

  1. Internal and Emergency Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Filippo Pieralli, Cristina Bazzini, Andrea Crociani & Carlo Nozzoli

  2. Internal Medicine Unit 4, Careggi University Hospital, Florence, Italy

    Alessia Fabbri & Alberto Moggi Pignone

  3. Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy

    Carlotta Casati, Francesco Corradi & Alessandro Morettini

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  1. Filippo Pieralli
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Correspondence to Filippo Pieralli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Pieralli, F., Bazzini, C., Fabbri, A. et al. The classification of hospitalized patients with hyperglycemia and its implication on outcome: results from a prospective observational study in Internal Medicine. Intern Emerg Med 11, 649–656 (2016). https://doi.org/10.1007/s11739-015-1358-6

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