Copyright
©The Author(s) 2015.
World J Diabetes. Jun 10, 2015; 6(5): 693-706
Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.693
Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.693
Table 1 Prevalence of diabetes in hospital population (chronological order)
Ref. | Year | R-D | UR-D | Total study patients | Location | Diabetes diagnosed by | Unrecognised diabetes diagnosed by |
Umpierrez et al[14] | 2002 | 495 (26%) | 2231 (12%) | 1886 | Atlanta, United States | Admission history | Fasting blood glucose ≥ 7 mmol/LRandom blood glucose ≥ 11.1 mmol/L × 2 |
Wallymahmed et al[15] | 2005 | 126 (11%) | 131 (1%) | 1129 | Liverpool, United Kingdom | Admission historyHospital records | Random blood glucose ≥ 11.1 mmol/L |
Wexler et al[17] | 2008 | 136 (19%) | 33 (5%) | 695 | Boston, United States | Admission historyHospital records | HbA1c > 6.5 |
Mazurek et al[18] | 2010 | 342 (35%) | 152 (16%) | 971 | New York, United States | Admission historyHospital recordsMedication review | HbA1c ≥ 6.5 |
Feldman-Billard et al[16] | 2013 | 355 (17%) | 1561 (7%) | 2141 | Multicentre (France) | Admission history | Fasting blood glucose ≥ 7 mmol/L |
Table 2 Prevalence of diabetes in the intensive care unit population (chronological order)
Ref. | Year | Study type | R-D | UR-D | Total study patients | Location | Recognised DM diagnosis | Unrecognised diabetes diagnosed by |
Van den Berghe et al[36] | 2001 | Interv | 204 (13%) | N/A | 1548 | Leuven, Belgium | Admission history | N/A |
Finney et al[27] | 2003 | Observ | 86 (16%) | N/A | 523 | London, United Kingdom | Unknown | N/A |
Whitcomb et al[23] | 2005 | Observ | 574 (21%) | 3951 (15%) | 2713 | Baltimore, United States | Admission history | Hyperglycaemia without a history of DM |
Van den Berghe et al[37] | 2006 | Interv | 203 (17%) | N/A | 1200 | Leuven, Belgium | Admission history | N/A |
Krinsely[24] | 2006 | Observ | 1110 (21%) | N/A | 5365 | Stamford, United States | Hospital records (ICD-9 codes) for the first 2 yr then all available info | N/A |
Egi et al[28] | 2008 | Observ | 728 (15%) | N/A | 4946 | Multicentre (Australia) | Hospital records | N/A |
Treggiari et al[25] | 2008 | Observ | 1361 (13%) | N/A | 10456 | Seattle, United States | Hospital records | N/A |
Arabi et al[39] | 2008 | Interv | 208 (40%) | N/A | 523 | Riyadh, Saudi Arabia | Admission historyHospital records | N/A |
Bronkhurst et al[38] | 2008 | Interv | 163 (30%) | N/A | 537 | Multicentre (Germany) | Unknown | N/A |
Del La Rosa et al[42] | 2008 | Interv | 61 (12%) | N/A | 504 | Medellin, Colombia | Admission history | N/A |
Finfer et al[41] | 2009 | Interv | 1211 (20%) | N/A | 6029 | Multicentre (Australia, NZ, Canada) | Admission history | N/A |
Preiser et al[40] | 2009 | Interv | 203 (19%) | N/A | 1078 | Multicentre (Europe) | Admission history | N/A |
Falciglia et al[26] | 2009 | Observ | 77850 (30%) | N/A | 259040 | Multicentre (United States) | Hospital records (ICD-9 codes) | N/A |
Stegenga et al[30] | 2010 | Observ | 188 (23%) | N/A | 830 | Multicentre (Worldwide) | Admission history | N/A |
Hermanides et al[29] | 2010 | Observ | 699 (12%) | N/A | 5961 | Amsterdam, Netherlands | Hospital records (computerised system) | N/A |
Krinsely et al[33] | 2011 | Observ | 669 (21%) | N/A | 3263 | Multicentre (United States, Europe) | Hospital records (ICU clinical database) | N/A |
Krinsley et al[32] | 2013 | Observ | 12880 (29%) | N/A | 44964 | Multicentre (Worldwide) | Admission history | N/A |
Plummer et al[34] | 2014 | Observ | 220 (22%) | 55 (6%) | 1000 | Adelaide, Australia | Admission historyPhone call to GPHbA1c ≥ 6.5 | HbA1c ≥ 6.5 without a history of DM |
Table 3 Prevalence of undiagnosed diabetes in the hospital population (chronological order)
Ref. | Year | Diagnosis | UR-D | Total study patients | Location | Patient population |
Norhammer et al[45] | 2002 | OGTT | 51 (31%) at discharge36 (25%) at 3 mo | 164 144 | Multicentre (Sweden) | Post AMI, Hospital/ICU |
George et al[47] | 2005 | Fasting blood glucose ≥ 7 mmol/L | 13 (3%) | 427 | London, United Kingdom | Emergency Department |
Wexler et al[17] | 2008 | HbA1c > 6.5 | 33 (5%) | 695 | Boston, United States | Hospital |
Lankisch et al[46] | 2008 | OGTT | 31 (32%) at discharge19 (31%) at 3 mo | 96 62 | Wuppertal, Germany | Post AMI, Hospital/ICU |
Mazurek et al[18] | 2010 | HbA1c ≥ 6.5 | 152 (16%) | 971 | New York, United States | Hospital |
Feldman-Billard et al[16] | 2013 | Fasting blood glucose≥ 7 mmol/L | 156 (7%) | 2141 | Multicentre (France) | Hospital |
Plummer et al[34] | 2014 | HbA1c ≥ 6.5 | 55 (6%) | 1000 | Adelaide, Australia | ICU |
Hoang et al[44] | 2014 | HbA1c ≥ 6.5 | 14 (14%) | 102 | New Haven, United States | Medical ICU |
Ochoa et al[43] | 2014 | HbA1c ≥ 6.5 | 8 (9%) | 92 | Abilene, United States | Hospital |
Table 4 Observational studies (diabetes as a binary variable) and outcomes related to hyperglycaemia (chronological order)
Ref. | Year | Study pts | Study point | Patients without diabetes | Patients with diabetes | Overall message |
Rady et al[35] | 2005 | 7285 | Glycaemia vs hospital mortality | Inc mortality with blood glucose > 8 mmol/L | Inc mortality with blood glucose > 11.1 mmol/L | Mortality inc in non diabetics (10%) compared to diabetics (6%), (P < 0.01) |
Whitcomb et al[23] | 2005 | 2713 | Admission hyperglycaemia (> 11.1 mmol/L) vs in-hospital mortality | Admission hyperglycaemia associated with inc mortality in CICU, CTICU and NSICU | Admission hyperglycaemia not associated with mortality | Mortality inc in non diabetics (10%) compared to diabetics (5%), (P < 0.05) |
Krinsely[24] | 2006 | 5365 | Pre ITT and post ITT vs hospital mortality | Dec mortality risk with mean blood glucose 3.9-6.7 mmol/LInc mortality risk with mean blood glucose > 7.8 mmol/LMortality drop 19% (pre-ITT) to 14% (post-ITT), P < 0.01 | Dec mortality risk with mean blood glucose 3.9-5.5 mmol/LInc mortality risk with mean blood glucose > 10.0 mmol/LNo statistically significant change in mortality pre and post ITT | Non-diabetics: 4.5-fold inc in mortality from lowest mean blood glucose, 3.9-5.5 mmol/L (9%) to highest, > 10mmol/L (40%)Diabetics: 2-fold inc in mortality from lowest mean blood glucose, 3.9-5.5 mmol/L (13%) to highest, > 10mmol/L (26%) |
Egi et al[28] | 2008 | 4896 | Glycaemia vs mortality | Inc risk of ICU mortality with hyperglycaemia - with non survivors spending more time with blood glucose > 8.0 mmol/L | No association with hyperglycaemia and ICU mortality Lower OR of death at all levels of hyperglycaemia | Diabetic patients: lower ICU mortality (P = 0.02)No difference in hospital mortality between groups (P = 0.3) |
Falciglia et al[26] | 2009 | 259040 | Glycaemia vs mortality | 5-fold inc in mortality from lowest mean blood glucose, 3.9-6.1 mmol/L (8%) to highest, > 16.7 mmol/L (41%) | 2-fold inc in mortality from lowest mean blood glucose, 3.9-6.1 mmol/L (6%) to highest, > 16.7 mmol/L (11%) | Hyperglycaemia associated with inc mortality in diabetics and non diabeticsMortality greater for hyperglycemic non diabetics patients |
Stegenga et al[30] | 2010 | 830 | DM vs outcomes of sepsis | Admission hyperglycaemia (> 11.1 mmol/L) associated with inc 28 and 90 d mortality (P < 0.03) | Admission hyperglycaemia had no effect on diabetic mortaltity | Diabetes did not influence mortality in sepsis |
Krinsley et al[32] | 2013 | 44964 | Hyperglycaemia, hypoglycaemia, and glycemic variability vs mortality (and how DM effects this) | Inc mortality with higher mean blood glucose (≥ 7.8 mmol/L)Dec mortality with lower blood glucose (4.4-7.8 mmol/L) | Inc mortality with mean blood glucose between 4.4-6.1 mmol/LDec mortality when blood glucose were higher (6.2-10 mmol/L) | Hyperglycaemia, hypoglycaemia, and increased glycemic variability are independently associated with mortality in ICU patientsDiabetic status tempers these relations |
Table 5 Interventional studies (diabetes as a binary variable) and outcomes related to hyperglycaemia (chronological order)
Ref. | Year | Study pts | Study point | Non diabetic patients | Diabetic patients | Overall message |
1Van den Berghe et al[54] | 2006 | 2748 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (insulin if blood glucose > 12 then target 10-11.1 mmol/L) on mortality | Reduced mortality and morbidity with ITT | No survival benefit with ITTHigher rates of hypoglycaemia | Hosp mortality 20% (40/200) of the DM patients in conventional arm Hosp mortality 22% (46/207) of the DM patients in the ITT arm |
Arabi et al[39] | 2008 | 523 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on ICU mortality | Mortality: ITT (14%) vs CIT (14%) - no significant difference (P = 0.2) | Mortality: ITT (13%) vs CIT (20%) - no significant difference (P = 0.3) | No significant difference in ICU mortality between IIT and CIT (P = 0.3) |
Brunkhorst et al[38] | 2008 | 537 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on mortality | 28 d mortality: ITT 25% vs CIT 23% (P = 0.8)90 d mortality: ITT 40% vs CIT 32% (P = 0.2) | 28 d mortality: ITT 25% vs CIT 32% (P = 0.3)90 d mortality: ITT 40% vs CIT 42% (P = 0.9) | No mortality benefit with ITT vs CITStopped early due to safety risk |
Del La Rosa et al[42] | 2008 | 504 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on morbidity and mortality | ICU mortality ITT 37% vs CIT 32% (no significance)2In-hospital mortality: ITT 40% vs CIT 39% (no significance)2 | Mortality: ITT (38%) vs CIT (31%) - no significant difference | No difference in ICU mortality, 28 d mortality or ICU infectionsIncreased hypoglycaemia in ITT |
Finfer et al[41] | 2009 | 6029 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose < 10 mmol/L) on mortality | Mortality: ITT (27%) vs CIT (24%) - no significant difference | Mortality: ITT (32%) vs CIT (28%) - no significant difference | ITT arm - inc 90 d mortalityNo difference in those with and without DM (P = 0.60) |
Preiser et al[40] | 2009 | 1078 | ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 7.8-10 mmol/L) on mortality | ICU mortality ITT 17% vs CIT 15% (P = 0.4) 2Hospital mortality: ITT 23% vs CIT 19% (P = 0.1)2 | Not described | Stopped early due to protocol violations |
Table 6 Observational studies that have recorded chronic glycaemia as a dynamic variable (chronological order)
Ref. | Year | Study pts | Study point | Non diabetic patients | Diabetic patients | Overall message |
Egi et al[55] | 2011 | 415 | Does preexisting hyperglycaemia modulate the association between glycemia and outcome in ICU patients with DM | N/A | Patients with elevated preadmission HbA1c levels (> 7%) showed a mortality benefit when mean ICU glucose concentrations were > 10 mmol/L | Relationship between HbA1c and mortality changed according to the levels of time-weighted average of blood glucose concentrations |
Plummer et al[34] | 2014 | 1000 | Prevalence of CIAH and recognized/unrecognized DM in ICU and to evaluate the premorbid glycaemia on the association between acute hyperglycaemia and mortality | 50% had CIAHRisk of death inc by 20% for each increase in acute glycaemia of 1 mmol/L | Well controlled DM (HbA1c < 6%) and adequately controlled (DM 6%-7%) - risk of death as per non diabetic patientHbA1c ≥ 7% (insufficiently controlled DM) had no significance between mortality and acute glycaemia | 22% had recognised DM6% had unrecognised diabetes |
Hoang et al[44] | 2014 | 299 | Prevalance of unrecognized DM amongst those with CIAH and the association between baseline glycaemia and mortality | 102 (34%) had no history of DM14/102 (14%) had unrecognized DM (diagnosed with HbA1c ≥ 6.5) | 197 (66%) had a history of DM | Lower HbA1c had inc mortality (in this population of CIAH patients) despite lower median glucose values and less glucose variabilityMortality in HbA1c < 6.5 (19%) vs HbA1c ≥ 6.5 (12%), P = 0.04 |
Table 7 Observational studies and outcomes related to hypoglycaemia (chronological order)
Ref. | Year | Study pts | Study point | Non diabetic patients | Diabetic patients | Overall message |
Krinsley and Grover[60] | 2007 | 408 | Risk factors for developing hypoglycaemia in ICU and outcomes | Severe hypoglycaemia associated with septic shock. Renal insufficiency, mechanical ventilation, illness severity and use of ITT | Associated with inc risk of severe hypoglycaemia (P < 0.01)DM had no association with mortality | Mortality in severe hypoglycaemia cohort 56% vs control cohort 40%, P < 0.01 |
Egi et al[61] | 2010 | 4946 | Hypoglycaemia vs risk of death in critically ill patients | Mild or moderate hypoglycaemia was associated with mortality in critically ill patientsMortality increases as severity of hypoglycaemia increases | Diabetic patients more likely to suffer from insulin-associated hypoglycaemia | 22% of total patients had one episode of hypoglycaemiaHospital mortality: hypoglycaemic cohort 37% vs control cohort 20%, P < 0.01 |
Krinsely et al[33] | 2011 | 62401 | Mild hypoglycaemia (blood glucose level < 3.9 mmol/L) vs risk of mortality in critically ill patients. | Mild hypoglycaemia was associated with a significantly increased risk of mortality | The association between hypoglycaemia and mortality was independent of diabetic status | Inc severity of hypoglycaemia was associated with inc risk of mortalityHypoglycemic patients had higher mortality regardless of diagnostic category and ICU LOS |
Krinsley et al[32] | 2013 | 44964 | Hyperglycaemia, hypoglycaemia, and glycemic variability vs mortality (and how DM effects this) | Inc mortality with higher mean blood glucose (≥ 7.8 mmol/L)Dec mortality with lower blood glucose (4.4-7.8 mmol/L) | Inc mortality with mean blood glucose between 4.4-6.1 mmol/LDec mortality when blood glucose were higher (6.2-10 mmol/L) | Hyperglycaemia, hypoglycaemia, and increased glycemic variability are independently associated with mortality in ICU patientsDiabetic status tempers these relations |
Table 8 Observational and interventional studies and outcomes related to glycaemic variability (chronological order)
Ref. | Year | Study pts | Study point | Non diabetic patients | Diabetic patients | Overall message |
Egi et al[65] | 2006 | 7049 | GV (measured by SD and %CV) vs mortality (hospital and ICU) | Both mean and GV of blood glucose were significantly and independently associated with ICU and hospital mortalityGV was a stronger predictor of ICU mortality than mean glucose concentration | Inc mortality when comparing highest and lowest glucose SDNo other significant relation with blood glucose (SD and mean) and ICU/hospital mortality Logistic regression: DM associated with decrease OR for ICU mortality | The mean ± SD of blood glucose: Survivors 1.7 ± 1.3 mmol/L vs Non survivors 2.3 ± 1.6 mmol/L (P < 0.001)Post logistic regression analysis, both mean and SD of blood glucose were significantly associated with ICU and hospital |
Ali et al[66] | 2008 | 1246 | GV vs hospital mortality in septic ICU patients | GV is independently associated with hospital mortality in sepsis | Mortality rise remained even after adjusting for a diagnosis of diabetes | Higher observed mortality with increasing levels of variabilityHigher odds of hospital mortality with lower mean blood glucose + high GV or higher mean blood glucose + lower GV |
Krinsely[67] | 2008 | 3252 | GV vs mortality in ICU patients | Inc GV conferred a strong independent risk of mortality | Multivariable regression analysis demonstrated that diabetes had an independent positive correlation to SD | Amount of GV had a significant effect on mortality - e.g., patients with mean blood glucose 3.9-5.5 mmol/L mortality: Lowest GV 6% while high GV 30% |
Krinsely[68] | 2009 | 4084 | Impact of DM or its absence on GV as a risk factor for mortality | Low GV was associated with increased survivalHigh GV was associated with increased mortality | Higher measures of GVNo association between GV and mortality among diabetics | Attempts to minimize GV may have a significant beneficial impact on outcomes of critically ill patients without diabetes |
Lundelin et al[69] | 2010 | 42 | Glycemic dynamics (measured via non-lineal dynamics) vs mortality in ICU patients | Loss of complexity (therefore higher variability) in glycaemia time series is associated with higher mortality | This association persisted in diabeticsNo difference in DFA (detrended fluctuation analysis a measure of complexity) between DM and nondiabetics | In critically ill patients, there is a difference in the complexity of the glycaemic profile between survivors and nonsurvivorsLoss of complexity correlates with higher mortality |
1Meyfroidt et al[71] | 2010 | 2 748 | Blood glucose signal characteristics vs hospital mortality, | GV was independently associated with hospital mortality | Increased mortality was seen in both diabetics and non diabetic patients. | Increased glucose amplitude variation was associated with mortality, irrespective of blood glucose level |
Hoang et al[44] | 2014 | 299 | Prevalance of unrecognized DM amongst those with CIAH and the association between baseline glycaemia and mortality | 102 (34%) had no history of DM14/102 (14%) had unrecognized DM (diagnosed with HbA1c ≥ 6.5) | 197 (66%) had a history of DM | Lower HbA1c had inc mortality (in this population of CIAH patients) despite lower median glucose values and less glucose variabilityMortality in HbA1c < 6.5 (19%) vs HbA1c ≥ 6.5 (12%), P = 0.04 |
Donati et al[70] | 2014 | 2 782 | GV and mean BGLs vs mortality and intensive care unit-acquired infections | High GV is associated with higher risk of ICU acquired infection and mortality | Diabetic patients had higher mean BGL and GVNo change in mortality or infections | Mean BGL was not associated with infections and mortality |
- Citation: Kar P, Jones KL, Horowitz M, Deane AM. Management of critically ill patients with type 2 diabetes: The need for personalised therapy. World J Diabetes 2015; 6(5): 693-706
- URL: https://www.wjgnet.com/1948-9358/full/v6/i5/693.htm
- DOI: https://dx.doi.org/10.4239/wjd.v6.i5.693