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

Van Ackerbroeck S, Schepens T, Janssens K, Jorens PG, Verbrugghe W, Collet S, Van Hoof V, Van Gaal L, De Block C - Crit Care (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. sofie.vanackerbroeck@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus

Overview of the inclusion process and glucose metabolism status. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2
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Fig1: Overview of the inclusion process and glucose metabolism status. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2

Mentions: This prospective, observational study was performed at the Antwerp University Hospital, Edegem, Belgium. During the study period between September 2011 and March 2013, a total of 3,985 adult critically ill patients were admitted to the 45-bed mixed medical-surgical ICU (nurse-to-patient ratio 1:2.5 to 1:3.0). Only adult patients aged between 18 and 85 years admitted for 48 h or longer to the ICU and who were still alive six months thereafter were eligible, leaving a total of 1,256 subjects. Subjects with known diabetes or any other glucose metabolism disturbance (impaired fasting glucose and/or impaired glucose tolerance) and individuals using glucose-lowering drugs were excluded from participation in this study (n = 262). Other exclusion criteria included estimated short life expectancy, pregnancy and/or a history of transplantation or acute pancreatic disease. Of the 395 subjects who agreed to participate, 47 did not show up for the OGTT, leaving 348 subjects, of whom another 10 were excluded, 4 of whom had existing disturbed glucose metabolism (treated by oral antidiabetic agents or insulin) and were missed on first approach. This resulted in 338 subjects being included in the study. These numbers can be found in Fig. 1.Fig. 1


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

Van Ackerbroeck S, Schepens T, Janssens K, Jorens PG, Verbrugghe W, Collet S, Van Hoof V, Van Gaal L, De Block C - Crit Care (2015)

Overview of the inclusion process and glucose metabolism status. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4591636&req=5

Fig1: Overview of the inclusion process and glucose metabolism status. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2
Mentions: This prospective, observational study was performed at the Antwerp University Hospital, Edegem, Belgium. During the study period between September 2011 and March 2013, a total of 3,985 adult critically ill patients were admitted to the 45-bed mixed medical-surgical ICU (nurse-to-patient ratio 1:2.5 to 1:3.0). Only adult patients aged between 18 and 85 years admitted for 48 h or longer to the ICU and who were still alive six months thereafter were eligible, leaving a total of 1,256 subjects. Subjects with known diabetes or any other glucose metabolism disturbance (impaired fasting glucose and/or impaired glucose tolerance) and individuals using glucose-lowering drugs were excluded from participation in this study (n = 262). Other exclusion criteria included estimated short life expectancy, pregnancy and/or a history of transplantation or acute pancreatic disease. Of the 395 subjects who agreed to participate, 47 did not show up for the OGTT, leaving 348 subjects, of whom another 10 were excluded, 4 of whom had existing disturbed glucose metabolism (treated by oral antidiabetic agents or insulin) and were missed on first approach. This resulted in 338 subjects being included in the study. These numbers can be found in Fig. 1.Fig. 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. sofie.vanackerbroeck@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus