HbA1c: A Prognostic Biomarker in the Surgical and Critically Ill Patient Population

Abstract

HYPERGLYCEMIA CAN OCCUR as part of the catabolic response to stress. 1 Clement S. Braithwaite S.S. Magee M.F. et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004; 27: 553-591 Crossref PubMed Scopus (975) Google Scholar , 2 Brealey D. Singer M. Hyperglycemia in critical illness: A review. J Diabetes Sci Technol. 2009; 3: 1250-1260 Crossref PubMed Scopus (74) Google Scholar Acute hyperglycemia is associated with a poor outcome and increased mortality under a variety of clinical conditions, most notably myocardial infarction, stroke, and major surgical tissue trauma. 3 Capes S.E. Hunt D. Gerstein H.C. et al. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: A systematic overview. Lancet. 2000; 355: 773-778 Abstract Full Text Full Text PDF PubMed Scopus (1744) Google Scholar , 4 Capes S.E. Hunt D. Gerstein H.C. et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: A systematic overview. Stroke. 2001; 32: 2426-2432 Crossref PubMed Scopus (1412) Google Scholar , 5 Finney S.J. Zekveld C. Evans T.W. et al. Glucose control and mortality in critically ill patients. JAMA. 2003; 290: 2041-2047 Crossref PubMed Scopus (884) Google Scholar , 6 van den Berghe G. Wouters P. Weekers F. et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001; 345: 1359-1367 Crossref PubMed Scopus (8191) Google Scholar Data from hospital admissions indicate that nondiabetic patients with newly diagnosed hyperglycemia have an increased risk of death. 7 Cheung N.W. Li S. Crampton R. et al. The relationship between admission blood glucose levels and hospital mortality. Diabetologia. 2008; 51: 952-955 Crossref PubMed Scopus (42) Google Scholar , 8 Umpierrez G.E. Isaacs S.D. Kitabchi A.E. et al. Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002; 87: 978-982 Crossref PubMed Scopus (1187) Google Scholar However, the evidence supporting a link between diabetes mellitus (DM) and increased mortality in critically ill and surgical patients is not as strong. 9 Egi M. Bellomo R. Stachowski E. et al. Blood glucose concentration and outcome of critical illness: The impact of diabetes. Crit Care Med. 2008; 36: 2249-2255 Crossref PubMed Scopus (274) Google Scholar , 10 Kosiborod M. Rathore S.S. Inzucchi S.E. et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: Implications for patients with and without recognized diabetes. Circulation. 2005; 111: 3078-3086 Crossref PubMed Scopus (517) Google Scholar , 11 Smith F.G. Sheehy A.M. Coursin D.B. et al. Critical illness-induced dysglycaemia: Diabetes and beyond. Crit Care. 2010; 14: 327 Crossref PubMed Scopus (35) Google Scholar , 12 Stegenga M.E. Vincent J.L. Vail G.M. et al. Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis. Crit Care Med. 2010; 38: 539-545 Crossref PubMed Scopus (88) Google Scholar , 13 Levetan C.S. Passaro M. Ratner R.E. et al. Unrecognized diabetes among hospitalized patients. Diabetes Care. 1998; 21: 246-249 Crossref PubMed Scopus (252) Google Scholar This may be caused partly by the underdiagnosis of DM and, thereby, falsely labeling diabetic patients as “nondiabetic.” 11 Smith F.G. Sheehy A.M. Coursin D.B. et al. Critical illness-induced dysglycaemia: Diabetes and beyond. Crit Care. 2010; 14: 327 Crossref PubMed Scopus (35) Google Scholar , 13 Levetan C.S. Passaro M. Ratner R.E. et al. Unrecognized diabetes among hospitalized patients. Diabetes Care. 1998; 21: 246-249 Crossref PubMed Scopus (252) Google Scholar