Believed related to oxidative stress, the long‐term effects of glycemic variability (GV) are associated with progression of microvascular complications in diabetics. Short‐term effects on increased mortality have been shown in nondiabetic, critically ill patients. The severity of sepsis correlates with hyperglycemia and severe hypoglycemia. Hypoglycemia is more common in diabetics with increased GV, suggesting a role for GV in the prediction of severe hypoglycemia. Continuous glucose measurement for the mean amplitude of glycemic excursion is not practical for the majority of hospitalized patients. This study characterized the effects of GV on morbidity and mortality in patients with sepsis for the purpose of predicting hypoglycemia via routine blood glucose (BG) monitoring.
This was a retrospective cohort study in an academic tertiary‐care hospital. Subjects were selected from 470 adults consecutively admitted to non–critical care units during 2009 with a primary diagnosis of septicemia and secondary diagnosis of hyperglycemia. Exclusion criteria were length of stay (LOS) < 72 hours or > 14 days; treatment with insulin infusion or corticosteroids diagnosis of diabetic ketoacidosis, hyperosmolar state, end‐stage liver disease, or pregnancy; creatinine > 3 mg/dL or CrCl < 30 mL/min; and lack of SIRS criteria on admission. Forty‐one patients, with a mean age of 65 years (range, 36–91 years), met inclusion criteria. GV was measured by averaging the first 10 BG measurements taken routinely by point‐of‐care testing during the first 48 hours of hospitalization, thus capturing fasting and interprandial glucose excursions. The standard deviation (SD) and coefficient of variation (CV) of the BG values were obtained for each subject. CV (SD corrected for BG mean) was used as the marker for increased individual GV. Outcomes measured were mortality, hyperglycemia (BG > 300), hypoglycemia (BG < 70), severe hypoglycemia (BG < 40), LOS, transfer to ICU, and 30‐ and 60‐day readmissions.
Results were grouped into statistically significant GV ranges (P = 0.0001) for analysis representing high, moderate, and low GV (see Table). None of the 41 patients died, were transferred to the ICU, or suffered severe hypoglycemia. Readmission rates and LOS were higher than those for other medicine patients but did not significantly differ among groups. Hypoglycemia occurred over 5 times more frequently in patients with high GV. Patients with the greatest GV were previously diagnosed with diabetes.
Limited by small sample size, this study shows increased GV (high SD and CV < 3) to be associated with increased hypoglycemia. Hospitalists should consider glycemic variability a risk factor for, and potentially predictive of, hypoglycemia in patients with diabetes and sepsis admitted to general medical units.
R. Y Meadows ‐ none; N. Fabre‐LaCoste ‐ none; A. Koshy ‐ none; S. S. Andrews ‐ none
To cite this abstract:Meadows R, Fabre‐LaCoste N, Koshy A, Andrews S. High Glycemic Variability and Hypoglycemia in Patients with Diabetes and Sepsis in a Non–Critical Care Setting: Can We Predict Hypoglycemic Events?. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 79. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/high-glycemic-variability-and-hypoglycemia-in-patients-with-diabetes-and-sepsis-in-a-noncritical-care-setting-can-we-predict-hypoglycemic-events/. Accessed April 3, 2020.