Impact Of Hyperglycemia In Patients Research Articles

Post Prandial Hyperglycemia: A Real Threat for Patients with Type 2 Diabetes Mellitus

The aim of this article is to evaluate the impact of postprandial hyperglycemia in patients with type 2 diabetes mellitus (T2DM). Postprandial hyperglycemia is a major determinant in overall glycemic control. Diabetic mellitus is an endocrine disorder steadily increasing worldwide, particularly in the developing countries like India. Diabetic patients are at high risk of cardiovascular events and mealtime plasma glucose fluctuations are important cardiovascular risk factors in type 2 diabetic patients. Diabetes is also one of the most important risk factors for chronic kidney disease. For diabetic patients with chronic kidney disease (CKD), the risk of cardiovascular disease is even higher. CKD can impair the ability of the kidneys to metabolize drugs and as a consequence a dose adjustment or an extended dose interval is usually needed in CKD patients in order to keep an optimal safety/efficacy profile. Oral hypoglycemic agents like glinides and alpha glucosidase inhibitors do not require dose adjustments and hence can be used safely in patients with CKD. Oral treatment with Repaglinide has proven beneficial effect on cardiovascular risk factors. It is therefore very important to use pharmacological tools allowing keeping post-meal glucose oscillations within narrow range. Regimens that target both fasting and post meal glycemia are needed to achieve optimal glucose control to prevent microvascular and macrovascular complications.

Dietary Adherence in Type 1 and 2 Diabetes

The adverse prognostic impact of hyperglycemia in patients with critical illness has focused considerable attention from expert groups and professional societies. In particular, an association between hyperglycemia and increased mortality and in-hospital complications in the time of acute coronary syndromes (ACS) has been confirmed in different studies [4,5]. In this setting, prevalence of hyperglycemia ranges from 3% to 71% according to different threshold of blood glucose used for diagnosis [4]. The lowest prevalence is observed with serum glucose levels of 169-306 mg/dl while, as expected, lower thresholds for diagnosing new hyperglycemia (108 mg/dl) is associated with the highest prevalence [4].

Impact of Hyperglycemia in Patients With Cervical Cancer Treated With Definitive Chemoradiation on Overall Survival and Locoregional Control

Impact of Hyperglycemia in Patients With Cervical Cancer Treated With Definitive Chemoradiation on Overall Survival and Locoregional Control

Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: The HORIZONS-AMI trial

BackgroundFew studies have examined the association between hyperglycemia and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We therefore evaluated the prognostic utility of admission hyperglycemia in the HORIZONS-AMI trial. Methods and resultsAdmission glucose levels were available in 3405 of 3602 (94.5%) enrolled patients, of which 566 patients (16.6%) were known to have diabetes. Outcomes were assessed at 30days and 3years, stratified by baseline glucose level and diabetes status. Median [IQR] admission glucose level in the entire study cohort was 138.0 [115.4, 171.0] mg/dl. Multivariable adjusted 30-day mortality was significantly increased in all patients with admission glucose in the highest glucose tertile vs. the lower two-thirds (HR [95%CI]=3.53 [1.89, 6.60], p<0.0001); in patients with diabetes (4.40 [2.04, 9.50], p=0.0002); and in patients without diabetes (3.33 [1.16, 9.55], p=0.03). By ROC analysis, the best cut-off values for 30-day mortality were 169mg/dl for all patients (AUC=0.76), 149mg/dl for patients without diabetes (AUC=0.77), and 231mg/dl for patients with diabetes (AUC=0.69). Baseline hyperglycemia was also an independent predictor of 3-year mortality in all patients (HR [95%CI]=1.93 [1.35, 2.76], P=0.0003), patients with diabetes (2.65 [1.28, 5.47], P=0.008), and patients without diabetes (1.58 [1.05, 2.36], P=0.03). ConclusionsIn patients with STEMI undergoing primary PCI, admission hyperglycemia is an independent predictor of early and late mortality in both patients with and without known diabetes.

The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Objective: According to a recent study, strict control of serum glucose level in patients result in decreased morbidity and mortality. But the clinical relationship of hyperglycemia in patients with severe traumatic brain injury (TBI) are controversial. So the purpose of this study was to evaluate the impact of hyperglycemia in patients with severe TBI. Methods: The authors performed a retrospective 68 chart reviews of severe TBI [Glasgow Coma Scale (GCS), score ≤8] who were admitted to the department of neurosurgery from January 2007 to December 2009. The age, sex, GCS score, injury severity score (ISS), initial serum blood glucose level, abbreviated injury score (AIS) head, length of stay in intensive care unit (ICU), body mass index (BMI) infection morbidity and mortality were mesured. The patients were divided into two groups by their serum glocose level (<200 mg/dL, ≥200 mg/dL). Patients with diabetes mellitus or below age of 18 was excluded from the study. Results: Patients’ age was from 19 to 84 years with a mean age of 53.7±19.17 years. There were 44 males (64.7%) and 24 females (35.3%). The average of GCS score was 5.3±1.8, ISS was 37.2±8.3, AIS was 5.3±0.7. Length of stay in ICU was 14.6±16.8 days, BMI was 22.3±2.9 and the average of serum blood glucose level was 197.4±72.9 mg/dL. Infection rate was 25% and death rate was 48.5%. Hyperglycemic group (≥200 mg/dL) had higher infection morbidity (13.2 vs. 11.7%, p<0.01) and mortality (28.0 vs. 20.1%, p<0.01) compared to nonhyperglycemic group. Univariate analysis showed that GCS score, length of ICU stays and hyperglycemia (≥200 mg/dL) was associated with infection morbidity and mortality (p<0.01). Conculusion: Initial hyperglycemia (≥200 mg/dL) is associated higher infection morbidity and mortality in patients with severe TBI. Strict control of early blood glucose level may be an important factor to improve outcomes of severe traumatic brain injury patients. (J Kor Neurotraumatol Soc 2010;6:23-26)

Serum glucose levels and hospital outcomes in patients with acute myocardial infarction without prior diabetes: a community-wide perspective

Elevated serum glucose levels are associated with an increased risk of adverse outcomes in patients with diabetes in the setting of acute myocardial infarction. It is, however, unclear whether a similar association exists in nondiabetic patients and whether this relationship is changing over time. The objectives of this population-based investigation were to examine the magnitude of elevated glucose levels in patients with acute myocardial infarction and the association between admission serum glucose levels and hospital outcomes in patients not known to have prior diabetes. The sample consisted of 3601 patients without a history of prior diabetes who were hospitalized with acute myocardial infarction at all greater Worcester (Massachusetts) medical centers in five biennial periods between 1995 and 2003. The average age of our study population was 70 years, 59% were men, and the average glucose level at the time of hospital admission was 149 mg/dl. Approximately one-third of patients presented with glucose levels<120 mg/dl, whereas one-quarter had serum glucose levels>or=160 mg/dl. Patients in the uppermost quintiles of serum glucose were significantly more likely to develop heart failure and cardiogenic shock, and die during hospitalization than patients with lower serum glucose levels. Patients with the highest glucose levels were less aggressively treated with effective cardiac medications and coronary interventions. The results of this population-based investigation provide insights into the magnitude and impact of hyperglycemia in patients not known to have prior diabetes who are hospitalized with acute myocardial infarction. Increased surveillance and more aggressive treatment strategies are needed to improve the outlook of patients with elevated serum glucose levels.

Hyperglycemia during Neutropenia Was Associated with the Risk of Infection and Organ Dysfunction in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation (HSCT).

Background Recipients of allogeneic HSCT frequently require support with total parenteral nutrition (TPN), in expense of increased risk of infections associated with hyperglycemia, particularly in neutropenic period. Previously, van den Berghe et al. showed that intensive insulin therapy reduced the morbidity including infections and mortality in patients cared in the ICU. Here we assessed the clinical impact of hyperglycemia in patients undergoing myeloablative HSCT.Methods A retrospective cohort of consecutive 112 adults treated between January 2002 and June 2006 was reviewed, and 21 patients were excluded due to coexisting infectious diseases, preexisting neutropenia or graft failure. The remaining 91 patients with various hematological malignancies were categorized according to mean blood glucose (BG) level, which developed in neutropenic period, to 1) “normoglycemia” (BG≤110 mg/dl, n=28), 2) “mild hyperglycemia” (110<BG≤150 mg/dl, n=49) and 3) “moderate hyperglycemia” (150 mg/dl<BG, n=14). Conditioning regimens included BU/CY (n=45), CY/TBI (n=43) and CA/CY/TBI (n=3). GVHD prophylaxis included cyclosporine- (n=62) and tacrolimus-based regimen (n=29). Stem cell sources included bone marrow (n=46), peripheral blood (n=41) and cord blood cells (n=4). Infection prophylaxis was oral ciprofloxacin, acyclovir and fluconazole. The primary endpoint of this study was the occurrence of febrile neutropenia (FN) and infectious episodes including bacteremia, pneumonia and central venous catheter infection. The secondary endpoint was abnormal laboratory data as parameters for organ dysfunction, which were used in the study by van den Berghe, including elevation of serum creatinine ≥2.0 mg/dl or more than twice of the baseline, serum total bilirubin ≥2.0 mg/dl and serum C-reactive protein (CRP) ≥15 mg/dl. For statistical analysis, student T, chi-square, and Wilcoxon rank-sum tests were used.Results There was no essential difference between the 3 groups in the average caloric intake, occurrence of FN and infectious episodes. However, hyperglycemia was significantly associated with higher number of febrile days (normoglycemia 3.3±3.7 days; mild hyperglycemia 5.5±4.1days p=0.017; moderate hyperglycemia 7.4±5.0days: p=0.004), hypercreatininemia (normoglycemia 3.6 %; moderate hyperglycemia 28.6% OR 10.8, p=0.018), hyperbilirubinemia (normoglycemia 10.7 %; moderate hyperglycemia 42.9% OR 6.3, p=0.017), CRP ≥15 mg/dl (normoglycemia 14.3 %; moderate hyperglycemia 64.3% OR 10.8, p<0.001), longer hospital stay (normoglycemia 43.0±20.5 days; mild hyperglycemia 60.7±31.3 days: p=0.003, moderate hyperglycemia 77.8±51.3 days; p=0.004) and in-hospital mortality (normoglycemia 0%, mild hyperglycemia 10.2%; p=0.08, moderate hyperglycemia 21.4%; p<0.001).Conclusion Hyperglycemia during neutropenia was associated with increased risk of infection and organ dysfunction, which further lead to vicious cycle of infectious complications. The results may support the possibility that intensive glucose control reduces the morbidity including infectious complications and organ dysfunction after HSCT.