The long-term metabolic outcomes of dysglycemia during critical illness

Abstract

Gornik and colleagues should be commended for providing the first report on the long-term glucose metabolism sequelae in survivors of critical illness with no apparent dysglycemia shortly after hospital discharge [1]. The authors hypothesized that hyperglycemia in the intensive care unit unmasks predisposition for future development of diabetes. The interpretation of their findings, however, is limited by several aspects of their methodology. No systematic control for covariates and confounders was performed. Their cohort was divided, as acknowledged by the authors, by an arbitrary (for the purpose of long-term prediction) glycemic cutoff value. While intuitively appealing, the latter is not necessarily the optimal predictor of future risk of impaired glucose metabolism. When considering the whole cohort of patients with a normal first postdischarge oral glucose tolerance test (the eligible cohort), what was the predictive role for traditional predictors of diabetes mellitus and prediabetes mellitus (DM/pre-DM) (for example, age, family history, body mass index) and for inhospital variables (for example, severity of illness)? It would also be instructive to explore the role of previously studied glycemic indices - such as admission, maximal and mean glucose values - to determine the best predictive cutoff value for future development of DM/pre-DM. In addition, almost 40% of the eligible cohort was excluded from analysis due to death or discontinuation of follow-up. How many of these patients who had at least the first 12-month follow-up were diagnosed with DM/pre-DM? Because DM/pre-DM are commonly under-recognized [2], these analyses can provide initial predictive modeling, which may inform future development of public health policy for earlier detection and intervention in survivors of critical illness.