Patients with hyperglycemia during ICU stay have higher risk of postdischarge diabetes
Critical illness-associated hyperglycemia is associated with a 4.1% risk of new-onset diabetes within five years of discharge, compared to 1.8% in patients who didn't develop high blood glucose levels in the ICU, a Swedish study found.
Critical illness-associated hyperglycemia in patients without pre-existing diabetes or prediabetes is associated with a higher risk of developing incident diabetes within five years of discharge, according to a retrospective cohort study from Sweden.
Researchers assessed data from 6,633 ICU survivors admitted between 2010 and 2021 who had a prior diabetes diagnosis recorded in the Swedish National Diabetes Register and an HbA1c level below 6% at admission. They defined hyperglycemia as insulin administration to maintain blood glucose levels between 6 and 10 mmol/L (108 to 180 mg/dl) in the ICU. Findings were published by Critical Care Medicine on Oct. 6.
Of the included patients, 3,100 (mean age, 63 years; 36.9% female) developed hyperglycemia in the ICU; insulin was initiated after a median of six hours after ICU arrival. Patients who developed hyperglycemia were older, were more often female, were more often obese, had higher HbA1c levels, and had more comorbidities than those who did not. At five years, their cumulative diabetes incidence was 4.1% (95% CI, 3.4% to 4.9%) compared to 1.8% (95% CI, 1.3% to 2.3%) in those who did not, corresponding to an adjusted hazard ratio of 2.15 (95% CI, 1.52 to 3.03). There was no statistically significant difference in five-year mortality between the two groups. Age between 50 and 64 years, body mass index greater than or equal to 25 kg/m2, and an HbA1c level greater than 5.7% at baseline were significantly associated with an increased risk of new-onset diabetes.
Limitations to the study include the absence of direct pre- and post-ICU metabolic assessments, along with a lack of data on ethnicity.
The study authors concluded that critical illness-associated hyperglycemia “may serve as a more comprehensive marker than early [stress-induced hyperglycemia] for identifying survivors at high risk, suggesting that those treated with insulin may benefit from structured diabetes screening and follow-up as part of post-intensive care syndrome management,” the authors concluded.