PURPOSE: Over the past few years there has been increasing recognition regarding the deleterious effects of hyperglycemia in critically ill patients. Control of blood glucose is advocated to improve outcomes including survival. We prospectively studied patients admitted to the medical intensive care unit (MICU) to determine factors associated with severe hyperglycemia.
METHODS: All patients admitted to the MICU between January 1, 2003 and December 31, 2005 were evaluated. Patients admitted with a primary diagnosis of uncontrolled hyperglycemia - diabetic ketoacidosis or hyperosmolar non acidotic diabetes - were excluded. Hemoglobin A1c was obtained from all patients within 24 hours of admission to the MICU. Baseline characteristics and medications were evaluated. Mode of nutrition (enteral vs parenteral) was studied, as well as use of concomitant medications. Severe hyperglycemia was defined as a blood glucose level of 250 mg% or greater on 3 or more occasions with at least an 8 hours duration.
RESULTS: Two thousand eight hundred forty three patients were studied. The mean age of the population was 76.3 (± 14.1). Patients with an admitting diagnosis of sepsis (of any severity) were twice as likely to demonstrate severe hyperglycemia (P=0.04). Patients with a prior history of non-compliance with diabetic medications were 2.5 times more likely than non-diabetics to have severe hyperglycemia (P=0.01). Patients whose baseline hemoglobin A1c was greater than 9, were 3.2 times more likely to require IV insulin to control blood glucose (P=0.01). Inravenous alimentation significantly increases the risk of hyperglycemia (P=0.001). Use of corticosteroids was associated with a 1.6 times risk of severe hyperglycemia (P=0.05).
CONCLUSION: A history of uncontrolled diabetes, treatment with steroids or IV alimentation, and an admitting diagnosis of sepsis are independent risk factors for developing severe hyperglycemia.
CLINICAL IMPLICATIONS: Aggressive control of blood glucose using intravenous insulin infusions should be considered for all critically ill patients at high risk for developing hyperglycemia.
DISCLOSURE: Arkady Vaknansky, None.