Abstract
PurposeTo determine whether glucose variability is altered during delirium days compared to non-delirious days in critically ill patients with and without diabetes in the intensive care unit (ICU).Materials and methodsCritically ill patients with delirious and non-delirious days during ICU stay were included from a prospective cohort study which was conducted from January 2011- June 2013. Glucose variability was measured each observation day using various definitions (change in mean glucose, standard deviation, mean absolute glucose, daily delta and occurrence of hypo- and hyperglycemia). Mixed-effects models and generalized mixed-effects models with logit link function were performed to study the association between delirium and glucose variability, adjusting for potential confounders.ResultsWith the exception of the risk of hypoglycemia, delirium was not linked to higher glucose variability using the various definitions of this estimate. For hypoglycemia, we did find an association with delirium in diabetic patients (OR adj.: 2.78; 95% CI: 1.71–6.32, p = 0.005), but not in non-diabetic patients (OR adj.: 1.16; 95% CI: 0.58–2.28, p = 0.689).ConclusionsDespite the positive association between delirium and hypoglycemia in critically ill patients with diabetes, delirium was not associated with more pronounced glucose variability. Our findings suggest that glucose levels should be monitored more closely in diabetic patients during delirium at the ICU to prevent hypoglycemia.
Highlights
Delirium is a frequently observed complication in patients in an intensive care unit (ICU) [1,2,3], that has been associated with long-term cognitive impairment [4,5], prolonged length of ICU stay [6] and with increased health care costs [6,7]
Despite the positive association between delirium and hypoglycemia in critically ill patients with diabetes, delirium was not associated with more pronounced glucose variability
We found similar results for glucose variability when all delirious and non-delirious days during ICU stay were analysed compared to the observation days of the first episode, or when consecutive episodes were analysed
Summary
Delirium is a frequently observed complication in patients in an intensive care unit (ICU) [1,2,3], that has been associated with long-term cognitive impairment [4,5], prolonged length of ICU stay [6] and with increased health care costs [6,7]. The pathophysiology of delirium is complex and heterogeneous. Metabolic disorders such as hypo- and hyperglycemia have been identified as risk factors for delirium onset, but extensive research is lacking [8,9,10,11]. Tight glucose control has been implemented as regular care in critically ill patients to reduce extreme glucose deviations as hypo- and hyperglycemia, glucose variability and to decrease the mean glucose concentration with decreased mortality risk as result [12,13]. Intensive glucose control (glucose target between 4.5–6.0 mmol/l (81.0–108.1 mg/dL)) has been shown to increase mortality rates compared to conventional glucose control (glucose target 10.0 mmol/l (180.1 mg/dL)) [14]. It has been reported that the mortality rate after hyperglycemia is higher in non-diabetic patients compared to diabetic patients [16,17], due to adaptive mechanisms to chronic hyperglycemia in patients with diabetes [18]
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