Incidence and predisposing factors for the development of disturbed glucose metabolism and DIabetes mellitus AFter Intensive Care admission: the DIAFIC study.

Abstract

INTRODUCTION:

Elevated blood glucose levels during intensive care unit (ICU) stay, so-called stress hyperglycaemia (SH), is a common finding. Its relation with a future diabetes risk is unclear. Our objective was to determine the incidence of disturbed glucose metabolism (DGM) post ICU admission and to identify predictors for future diabetes risk with a focus on stress hyperglycaemia.

METHODS:

This single center prospective cohort trial (DIAFIC trial) had a study period between September 2011 and March 2013, with follow-up until December 2013. The setting was a mixed medical/surgical ICU in a tertiary teaching hospital in Belgium. 338 patients without known diabetes mellitus were included for analysis. We assessed the level of glucose metabolism disturbance (as diagnosed with a 75 g oral glucose tolerance test (OGTT) and/or HbA1c level) eight months after ICU admission, and investigated possible predictors including stress hyperglycaemia.

RESULTS:

In total 246 patients (73 %) experienced stress hyperglycaemia during the ICU stay. Eight months post-ICU admission, 119 (35 %) subjects had a disturbed glucose metabolism, including 24 (7 %) patients who were diagnosed with diabetes mellitus. A disturbed glucose metabolism tended to be more prevalent in subjects who experienced stress hyperglycaemia during ICU stay as compared to those without stress hyperglycaemia (38 % vs. 28 %, P = 0.065). HbA1c on admission correlated with the degree of stress hyperglycaemia. A diabetes risk score (FINDRISC) (11.0 versus 9.5, P = 0.001), the SAPS3 score (median of 42 in both groups, P = 0.003) and daily caloric intake during ICU stay (197 vs. 222, P = 0.011) were independently associated with a disturbed glucose metabolism.

CONCLUSIONS:

Stress hyperglycaemia is frequent in non-diabetic patients and predicts a tendency towards disturbances in glucose metabolism and diabetes mellitus. Clinically relevant predictors of elevated risk included a high FINDRISC score and a high SAPS3 score. These predictors can provide an efficient, quick and inexpensive way to identify patients at risk for a disturbed glucose metabolism or diabetes, and could facilitate prevention and early treatment.

TRIAL REGISTRATION:

At ClinicalTrials.gov NCT02180555 . Registered 1 July, 2014.

• Authors: Sofie Van Ackerbroeck, Tom Schepens, Karolien Janssens, Philippe G Jorens, Walter Verbrugghe, Sandra Collet, Viviane Van Hoof, Luc Van Gaal, Christophe De Block
• Journal: Critical care (London, England) (Crit Care) Vol. 19 Pg. 355 (Oct 02 2015) ISSN: 1466-609X [Electronic] England
• PMID: 26428846 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Glycated Hemoglobin A
• hemoglobin A1c protein, human
• Glucose

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Critical Care (statistics & numerical data)
• Diabetes Mellitus (epidemiology, etiology)
• Female
• Glucose (metabolism)
• Glucose Tolerance Test
• Glycated Hemoglobin (analysis)
• Humans
• Hyperglycemia (epidemiology, etiology)
• Incidence
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Stress, Physiological
• Young Adult