Glycemic Lability Index Research Articles

The association between early blood glucose fluctuation and prognosis in critically ill patients

To investigate the association between early blood glucose level fluctuation and prognosis of critically ill patients. A retrospective study involving 95 critically ill patients in intensive care unit (ICU) was conducted. According to the 28-day outcome after admission to ICU, the patients were divided into nonsurvivors (43 cases) and survivors (52 cases), and the blood glucose level in them was monitored in the first 72 hours. Blood glucose concentration at admission (BGadm), mean blood glucose level (MBG), hyperglycemia index (HGI), glycemic lability index (GLI), incidence of hypoglycemia and total dosage of intravenous insulin for each patient were compared. The index as an independent risk factor of mortality was determined by multivariate logistic regression analysis and the predictor value by comparing the area under the receiver operating characteristic curve (ROC curve, AUC) of each index. The BGadm (mmol/L), MBG (mmol/L), HGI and the incidence of hypoglycemia showed no significant differences between nonsurvivors and survivors [BGadm: 9.87 ± 4.48 vs. 9.26 ± 3.07, MBG: 8.59 ± 1.23 vs. 8.47 ± 1.01, HGI(6.0): 2.45 ± 0.94 vs. 1.68 ± 1.05, HGI(8.3): 0.84 ± 0.70 vs. 0.68 ± 0.51, the incidence of hypoglycemia: 9.30% vs. 5.77%, all P > 0.05], but acute physiology and chronic health evaluation II (APACHE II ) score, GLI and the total dosage of intravenous insulin (U) were significantly higher in nonsurvivors than survivors [APACHE II score: 23 ± 6 vs. 19 ± 6, GLI: 56.96 (65.43) vs. 23.87 (41.62), the total dosage of intravenous insulin: 65.5 (130.5) vs. 12.5 (90.0), all P < 0.05]. Multivariate logistic regression analysis showed that APACHE II score and GLI were both independent risk factors [APACHE II score: odds ratio (OR) = 1.09, 95% confidence interval (95%CI) 1.01-1.17; GLI: OR = 1.03, 95%CI 1.01-1.06, both P < 0.05]. When ROC curve was plotted, the AUC of APACHE II score and GLI was respectively 0.69 and 0.71, and there was no significant difference (P > 0.05). Early fluctuation of blood glucose is a significant independent risk factor of mortality in critically ill patients. Control the early fluctuation of blood glucose concentration might improve the patients' outcome.

Values of glycemic lability index in the prognostic evaluation of critically ill patients in intensive care unit

To access the predictive values of glycemic lability index (GLI) as an indicator of glucose variability in the prognosis of critically ill patients. A prospective study of 72 critically ill patients admitted into intensive care unit (ICU) were performed. Capillary glucose was measured on admission and every 2 hrs afterward during the first 24 hrs. GLI, mean amplitude of glycemic excursion (MAGE), largest amplitude of glycemic excursions (LAGE), mean, standard deviation (SD) and coefficient of variability (CV) were calculated respectively. The 30 day mortality was selected as the end-point. Receiver operating curve (ROC) was drawn to explore the association between each indicator of glucose variability and prognosis. The subjects were subsequently divided into 4 subgroups according to the median of mean and GLI. The 30-day mortality was then compared between the subgroups. Thirty-one of 72 patients died with a mortality rate of 43.1%. The area under the curve (AUC) of GLI (0.798 ± 0.051) was superior to that of MAGE (0.785 ± 0.053), LAGE (0.772 ± 0.056), SD (0.761 ± 0.056), CV (0.729 ± 0.059) and mean (0.670 ± 0.065) under the determination of ROC respectively. GLI was significantly correlated with APACHE II (acute physiology and chronic health evaluation II) score assessed during the first 24 hrs after admission (R(2) = 0.787, P < 0.001). With the rise of GLI value, the 30-day mortality also increased gradually. Subgroup analysis demonstrated that the duration of mechanical ventilation, the incidence of multiple organ failure (MOF), the utilization rate of CRRT (continuous renal replacement therapy), the staying length of ICU and the 30 mortality rate was (3.3 ± 4.4) d, 41.6%, 12.5%, (4.6 ± 4.5) d and 16.7% respectively in the low mean +low GLI subgroup. They decreased obviously compared to the low mean +high GLI, high mean +low GLI and high mean +high GLI groups. Therefore the low mean +low GLI subgroup had the best prognosis while the high mean +high GLI subgroup worst. GLI of the first 24 hrs after ICU admission can serve as an indicator of glucose variability. And it is significantly correlated with the patient prognosis.

Hypoglycemia Risk and Glucose Variability Indices Derived from Routine Self-Monitoring of Blood Glucose Are Related to Laboratory Measures of Insulin Sensitivity and Epinephrine Counterregulation

the widely held assumptions that in type 1 diabetes glucose variability may correlate with insulin sensitivity and impaired epinephrine counterregulation have not been studied directly. Here we investigate possible relationships between outpatient measures of glucose variability and risk for hypoglycemia with physiological characteristics: insulin sensitivity and hypoglycemia counterregulation. thirty-four subjects with type 1 diabetes (14 women, 20 men; 37 ± 2.1 years old; glycosylated hemoglobin [HbA1c], 7.6 ± 0.21%) performed self-monitoring of blood glucose (SMBG) for a month, followed by an inpatient hyperinsulinemic euglycemic and hypoglycemic clamp. SMBG field data were used to calculate measures of glucose variability and risk of hypoglycemia, while the clamp procedure was used to evaluate insulin sensitivity and epinephrine response during induced hypoglycemia. Spearman partial correlations adjusted for age, duration of diabetes, body mass index, gender, and HbA1c were used to assess the relationship between the field indices of glucose variability and the physiological characteristics of diabetes. two glucose variability measures correlated positively (P < 0.01) with insulin sensitivity: the Average Daily Risk Range (ADRR) (ρ = 0.5) and the Glycemic Lability Index (ρ = 0.48). The Low Blood Glucose Index, a measure of the risk for hypoglycemia, and the ADRR correlated negatively with maximum epinephrine response during hypoglycemia: ρ = -0.46, P < 0.01 and ρ = -0.4, P = 0.03, respectively. higher insulin sensitivity and lower epinephrine response during hypoglycemia are related to increased glucose variability (as quantified by the ADRR), irrespective of HbA1c and other patient characteristics. Lower epinephrine relates to risk for hypoglycemia as well.

Relationship Between Glycemic Control and Readmission Rates in Patients Hospitalized With Congestive Heart Failure During Implementation of Hospital-Wide Initiatives

To determine the relationship between inpatient glycemic control and hospital readmission in patients with congestive heart failure (CHF). We used an electronic data collection tool to identify patients with a discharge diagnosis of CHF who underwent point-of-care glucose assessments. Timeweighted mean glucose (TWMG), hemoglobin A1c, and glycemic lability index (GLI) served as glycemic indicators, and readmission for CHF was determined at 30 days and between 30 and 90 days. The analysis included 748 patients. After adjustment for significant covariates, log-transformed increasing TWMG (odds ratio 3.3; P = .03) and log-transformed hemoglobin A1c (odds ratio 5.5; P = .04) were independently associated with higher readmission for CHF between 30 and 90 days, but not by 30 days. Renal disease, African American race, and year of hospital admission were also significantly associated with readmission, but GLI was not. There was no significant difference in TWMG when analyzed on the basis of race or renal status. We noted a decrease in TWMG (P = .004) and a trend for reduction in readmission rates between 30 and 90 days (P = .06) after hospital-wide interventions were implemented to improve glycemic control, but no significant difference was detected in GLI or hypoglycemia. Increasing glucose exposure, but not glycemic variability, was associated with higher risk of readmission between 30 and 90 days in patients with CHF. Prospective studies are needed to confirm or refute these results.

Glucose variability and mortality in patients with sepsis*

Treatment and prevention of hyperglycemia has been advocated for subjects with sepsis. Glucose variability, rather than the glucose level, has also been shown to be an important factor associated with in-hospital mortality, in general, critically ill patients. Our objective was to determine the association between glucose variability and hospital mortality in septic patients and the expression of glucose variability that best reflects this risk. Retrospective, single-center cohort study. Academic, tertiary care hospital. Adult subjects hospitalized for >1 day, with a diagnosis of sepsis were included. None. Glucose variability was calculated for all subjects as the average and standard deviation of glucose, the mean amplitude of glycemic excursions, and the glycemic lability index. Hospital mortality was the primary outcome variable. Logistic regression was used to determine the odds of hospital death in relation to measures of glucose variability after adjustment for important covariates. Of the methods used to measure glucose variability, the glycemic lability index had the best discrimination for mortality (area under the curve = 0.67, p < 0.001). After adjustment for confounders, including the number of organ failures and the occurrence of hypoglycemia, there was a significant interaction between glycemic lability index and average glucose level, and the odds of hospital mortality. Higher glycemic lability index was not independently associated with mortality among subjects with average glucose levels above the median for the cohort. However, subjects with increased glycemic lability index, but lower average glucose values had almost five-fold increased odds of hospital mortality (odds ratio = 4.73, 95% confidence interval = 2.6-8.7) compared with those with lower glycemic lability index. Glucose variability is independently associated with hospital mortality in septic patients. Strategies to reduce glucose variability should be studied to determine whether they improve the outcomes of septic patients.