Stress-induced Hyperglycemia Research Articles

COMPLETE AUDIT CYCLE: PERI-OPERATIVE GLYCEMIC CONTROL IN CMH LAHORE

Hyperglycemia is associated with an increased risk of complications in patients undergoing surgery. Hyperglycemia from diabetes must be differentiated from stress-induced hyperglycemia, which typically presents post-operatively and resolves as the surgery-induced stress subsides. It is imperative to differentiate between the two due to the severe complications of diabetic hyperglycemia, which can often be confused with its stressed induced counterpart. Good glycemic control is the best strategy to avoid post-operative complications and morbidity. An assessment of peri-operative blood glucose levels of known diabetics admitted to CMH Lahore was done, and recommendations were introduced to achieve better glycemic control. Subsequently preventing post-surgical complications, improving wound healing and overall recovery, and ultimately decreasing morbidity. The aim of the audit was the assessment of peri-operative glycemic control in known diabetics admitted for surgery in CMH Lahore. Existing problems regarding poor glycemic control were identified, and recommendations were given to rectify said problems. We aimed to study the effectiveness of glucose control due to these planned interventions. Patients were included based on eligibility criteria, and a record of the patients was updated daily on the Excel sheet using the glucose control audit tool (attached below). The highest BSR reading per day was added. Good or poor glycemic control was determined by the highest BSR readings on post-op days 0, 1, and 2. If 2 or more readings met the criteria for good glycemic control, the patient was labeled to have good glycemic control. In Cycle 1, patients were managed peri-operatively with insulin as per the sliding scale. 13% of patients had good glycemic control on this regimen. Interventions were introduced for Cycle 2, with the recommendation of altering insulin/drug regimens as per NHS/ADA guidelines. 16.6% of patients were found to achieve good glycemic control; however, it was noted that these recommendations were not followed consistently. Based on the results, it can be concluded that the management of inpatient diabetes is a team effort, interventions recommended using established guidelines should be followed stringently, and existing protocols should be updated accordingly. Proper management of inpatient hyperglycemia starts with each team member performing their respective role to their best; this is vital in preventing post-operative complications associated with poor glycemic control.

A Review of Hyperglycemia in COVID-19.

Diabetes mellitus (DM) is one of the most common chronic metabolic disorders worldwide, which increases the risk of common and opportunistic infections. Following the coronavirus disease2019 (COVID-19) pandemic, a higher incidence rate, more severe forms of the disease, and exacerbation of hyperglycemia and its complications have been observed in patients with DM. Moreover, stress-induced hyperglycemia has been observed in many hospitalized nondiabetic patients after contracting COVID-19. Hyperglycemia worsens prognosis in both diabetic and nondiabetic patients. In this study, the mechanism of new-onset or exacerbation of hyperglycemia, the effect of the treatments used for COVID-19 on hyperglycemia, the importance and appropriate method of blood glucose (blood sugar (BS)) control during the disease, and the possible fate of new-onset hyperglycemia after recovery from COVID-19 to some extent is expressed.

Positive association between stress hyperglycemia ratio and pulmonary infection in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

BackgroundPrevious studies have shown that the stress hyperglycemia ratio (SHR), a parameter of relative stress-induced hyperglycemia, is an excellent predictive factor for all-cause mortality and major adverse cardiovascular events (MACEs) among patients with ST-segment elevation myocardial infarction (STEMI). However, its association with pulmonary infection in patients with STEMI during hospitalization remains unclear.MethodsPatients with STEMI undergoing percutaneous coronary intervention (PCI) were consecutively enrolled from 2010 to 2020. The primary endpoint was the occurrence of pulmonary infection during hospitalization, and the secondary endpoint was in-hospital MACEs, composed of all-cause mortality, stroke, target vessel revascularization, or recurrent myocardial infarction.ResultsA total of 2,841 patients were finally included, with 323 (11.4%) developing pulmonary infection and 165 (5.8%) developing in-hospital MACEs. The patients were divided into three groups according to SHR tertiles. A higher SHR was associated with a higher rate of pulmonary infection during hospitalization (8.1%, 9.9%, and 18.0%, P < 0.001) and in-hospital MACEs (3.7%, 5.1%, and 8.6%, P < 0.001). Multivariate logistic regression analysis demonstrated that SHR was significantly associated with the risk of pulmonary infection during hospitalization (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.06–2.02, P = 0.021) and in-hospital MACEs (OR = 1.67, 95% CI 1.17–2.39, P = 0.005) after adjusting for potential confounding factors. The cubic spline models demonstrated no significant non-linear relationship between SHR and pulmonary infection (P = 0.210) and MACEs (P = 0.743). In receiver operating characteristic curve, the best cutoff value of SHR for pulmonary infection was 1.073.ConclusionsThe SHR is independently associated with the risk of pulmonary infection during hospitalization and in-hospital MACEs for patients with STEMI undergoing PCI.

New stress-induced hyperglycaemia markers predict prognosis in patients after mechanical thrombectomy

ObjectiveStress-induced hyperglycaemia (SIH) is a frequent phenomenon that occurs in patients with acute ischaemic stroke. The aim of this study was to investigate the relationship between SIH and the prognosis of mechanical thrombectomy (MT) patients according to the stress hyperglycemia ratio (SHR) and glycaemic gap (GG) indicators, as well as explore its relationship with haemorrhagic transformation (HT).MethodsPatients were enrolled from January 2019 to September 2021 in our centre. SHR was calculated as fasting blood glucose divided by the A1c-derived average glucose (ADAG). GG was calculated as fasting blood glucose minus ADAG. Logistic regression was used to analyse SHR, GG with outcome and HT.ResultsA total of 423 patients were enrolled in the study. The incidence of SIH was as follows: 191/423 of patients with SHR > 0.89, 169/423 of patients with GG > -0.53. SHR > 0.89 (OR: 2.247, 95% CI: 1.344–3.756, P = 0.002) and GG>-0.53 (OR: 2.305, 95% CI: 1.370–3.879, P = 0.002) were both associated with poor outcomes (modified Rankin Scale > 2) at Day 90 and an increase risk of HT. Additionlly, receiver operating characteristic curves were used to assess the predictive performance of the SHR and GG on outcomes. The area under the curve for SHR to predict poor outcomes was 0.691, with an optimal cut-off value of 0.89. The area under the curve for GG was 0.682, with an optimal cut-off value of -0.53.ConclusionHigh SHR and high GG are strongly associated with poor 90-day prognosis in MT patients and an increased risk of HT.

Incidence of Stress-Induced Hyperglycemia in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

The aim of this study was to systematically evaluate the incidence of stress-induced hyperglycemia (SIH) in acute ischemic stroke (AIS). Studies that reported SIH incidence in AIS and examined risk factors for SIH and non-SIH patients were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science from the inception of each database to December 2021. Article screening and data extraction were performed by two independent reviewers according to the inclusion and exclusion criteria. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analysis was performed using Stata. A total of 13 studies involving 4552 patients (977 in the SIH group and 3575 in the non-SIH group) were included. Meta-analysis showed that the incidence of SIH was 24% (95% CI: 21-27%) in the total population, 33% (14-52%) in North America, 25% (20-29%) in Europe, and 21% (12-29%) in Asia. Subgroup analysis by year of publication revealed that the pooled incidence of SIH was 27% (22-32%) in studies published before 2010 and 19% (14-24%) in those published after 2010. SIH is relatively common in AIS and poses a serious public health problem. Therefore, more emphasis should be placed on the prevention and control of SIH in AIS.

A review of stress-induced hyperglycaemia in the context of acute ischaemic stroke: Definition, underlying mechanisms, and the status of insulin therapy.

The transient elevation of blood glucose produced following acute ischaemic stroke (AIS) has been described as stress-induced hyperglycaemia (SIH). SIH is common even in patients with AIS who have no previous diagnosis of diabetes mellitus. Elevated blood glucose levels during admission and hospitalization are strongly associated with enlarged infarct size and adverse prognosis in AIS patients. However, insulin-intensive glucose control therapy defined by admission blood glucose for SIH has not achieved the desired results, and new treatment ideas are urgently required. First, we explore the various definitions of SIH in the context of AIS and their predictive value in adverse outcomes. Then, we briefly discuss the mechanisms by which SIH arises, describing the dual effects of elevated glucose levels on the central nervous system. Finally, although preclinical studies support lowering blood glucose levels using insulin, the clinical outcomes of intensive glucose control are not promising. We discuss the reasons for this phenomenon.

Chronic stress boosts systemic inflammation and compromises antiviral innate immunity in Carassius gibel.

It is generally considered that stress causes decreased immune function and render fish vulnerable to infection and diseases. However, the molecular mechanisms between stress responses and susceptibility to infections, especially viral diseases, in fish remain unknown. Understanding and monitoring the biological consequences and mechanisms underlying stress responses in fish may contribute to the improvement of animal welfare and production efficiency. In this study, long-term exposure to a variety of stressors, including chasing, overcrowding, restraint stress, and air exposure mimicking chronic stresses, in aquaculture practices was conducted in Carassius gibel to investigate the consequences of chronic stress on inflammation and antiviral capability. With the continuation of stimulation, experimental fish gradually became insensitive to the stress of net chasing and feeding with the accompaniment of upregulated gene expressed in the HPI axis and elevated levels of stress hormones. As expected, stress-induced hyperglycaemia with a decrease in the insulin signaling pathway and altered gene expression in glycolysis and gluconeogenesis, suggesting the disturbance of glycometabolism. Importantly, a link between intestinal homoeostasis and systemic low-grade inflammation in stressed C. gibel was observed, implying crosstalk among the brain, intestine, and other organs. Furthermore, the compromised antiviral capability with impaired antiviral innate immunity in stressed fish was confirmed by RNA sequencing and infection with Cyprinid herpesvirus 2 (CyHV-2), promoting the understanding of enhanced susceptibility to viral infection in stressed fish.

Large vessel occlusion stroke outcomes in diabetic vs. non-diabetic patients with acute stress hyperglycemia.

This study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status. This retrospective study collected data from 576 patients with AIS due to large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale (mRS) at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into four groups by quartiles of GAR (Q1-Q4). Binary logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT. In DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27 ± 0.44. These variables were higher than non-DM group and the differences were statistically significant (p < 0.05, respectively). Patients with severe stress-induced hyperglycemia demonstrated greater incidence of 3-month poor prognosis (DM: Q1, 39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; p = 0.009. Non-DM: Q1, 31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; p < 0.001). However, the highest quartile of GAR was independently associated with poor prognosis at 3 months (OR 3.39, 95% CI 1.66-6.96, p = 0.001), compared to the lowest quartile in non-DM patients after logistic regression. This association was not observed from DM patients. The outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis at 3-month in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and diabetic patients' adaptive response to stress following acute ischemic damage to the brain.

Тяжелое течение целиакии, осложненной стрессовой гипергликемией

This article presents a clinical case of lately diagnosed celiac disease complicated by stress-induced hyperglycemia. A 2-yearold patient was admitted to the intensive care unit of the Republican Specialized Scientific and Practical Medical Center of Pediatrics with severe protein-energy malnutrition, lethargy, abdominal bloating, and constipation. On admission, the child had hypoproteinemia, hypoalbuminemia, blood glucose levels up to 11.7 mmol/L, and anemia. On the third day of illness, blood glucose levels reached 16 mmol/L, which was considered as stress-induced hyperglycemia. Glucose levels were reduced by insulin injections on day 9. Celiac disease was suspected based on complaints, anamnestic, clinical and laboratory findings. Examination revealed elevated levels of IgA antibodies to tissue transglutaminase, exceeding the reference values 15 times. Genetic study confirmed the presence of predisposition to the disease. Catamnestic follow-up demonstrated a positive effect of a gluten-free diet. This is the first description of a typical form of celiac disease with late diagnosis and complications such as stress-induced hyperglycemia, respiratory failure, protein-energy malnutrition, and protein-losing enteropathy. Early diagnosis is very important to prevent long-term complications. Key words: children, malabsorption, celiac disease, stress hyperglycemia, protein-losing enteropathy

Glucokinase maturity-onset diabetes of the young as a mimicker of stress hyperglycemia: a case report

Febrile seizures are frequently accompanied by stress-induced hyperglycemia. Herein, we report the case of a 1.5-yr-old girl with hyperglycemia during febrile seizures who was subsequently diagnosed with glucokinase (GCK) maturity-onset diabetes of the young (MODY), considering its distinction from stress hyperglycemia. Following the development of febrile seizures owing to adenovirus infection, the patient presented a casual blood glucose level was 185 mg/dL. She had a multigenerational family history of diabetes and a hemoglobin A1c (HbA1c) level of 6.4%. Owing to the persistent glucose intolerance until the age of 5 years, genetic testing was performed, which revealed a heterozygous mutation in GCK, and the patient was diagnosed with GCK-MODY. Precise diagnosis of GCK-MODY individuals is important to avoid administering unnecessary antidiabetic medications. Even during hyperglycemia under stress, multigenerational diabetes and mildly elevated HbA1c levels can suggest GCK-MODY.

Stress-induced Hyperglycemia Ratio as an Independent Risk Factor of In-hospital Mortality in Nonresuscitation Intensive Care Units: A Retrospective Study

PurposeTo determine whether the stress-induced hyperglycemia ratio (SHR) is independently associated with in-hospital mortality in critically ill patients in nonresuscitation ICUs. MethodsIn this retrospective cohort study, clinical- and laboratory-related data from patients first admitted to nonresuscitation ICUs were extracted from an open-access database of >50,000 ICU admissions. Patients were assigned to one of two groups according to an SHR threshold of 1.1. The primary end point of this study was the in-hospital mortality rate. The associations between SHR and length of stay in the ICU and hospital, duration of mechanical ventilation use, and vasopressor use were secondary end points. Logistic regression models were established in the analysis of in-hospital mortality risk, and areas under the receiver operating characteristic curve (AUC) were analyzed to investigate the association between the primary end point and SHR used alone or together with the Simplified Acute Physiology Scale (SAPS) II score. The Youden index, specificity, and sensitivity of SHR and SAPS-II were also assessed. FindingsIn this study, 1859 patients were included, 187 of whom (10.06%) died during hospitalization. The group with an SHR of ≥1.1 had a greater in-hospital mortality rate (13.7% vs 7.4%; P < 0.001), longer length of stay both in the ICU and in the hospital, a longer duration of mechanical ventilation use, and a greater rate of vasopressor use. On adjustment for multivariate risk, a 0.1-point increment in SHR was significantly associated with in-hospital mortality (OR = 1.08; 95% CI, 1.00–1.16; P = 0.036). The AUC of the association between risk and the SAPS-II score was significantly greater than that with SHR (0.797 [95% CI, 0.576–0.664] vs 0.620 [95% CI, 0.764–0.830]; P < 0.001). The AUC with SAPS-II + SHR was significantly greater than that with SAPS-II used alone (0.802 [95% CI, 0.770–0.835] vs 0.797 [95% CI, 0.764-0.830]; P = 0.023). The Youden index, specificity, and sensitivity of SAPS-II + SHR were 0.473, 0.703, and 0.770, respectively. ImplicationsStress-induced hyperglycemia, as evaluated using the SHR, was associated with increased in-hospital mortality and worse clinical outcomes in these critically ill patients in nonresuscitation ICUs. SHR was an independent risk factor for in-hospital mortality, and when used together with the SAPS-II, added to the capacity to predict mortality in these patients in nonresuscitation ICUs. Prospective data are needed to validate the capacity of SHR in predicting in-hospital mortality in patients in the nonresuscitation ICU.

Risk of postoperative complications in hyperglycemic conditions

The authors consider the influence of carbohydrate metabolism disorders on postoperative period. Data on the influence of diabetes mellitus on morbidity are summarized. Mechanisms and significance of stress-induced hyperglycemia are described. The authors also discuss modern approaches to the treatment of hyperglycemic conditions in perioperative period.

Hepatic responses following acute ischemic stroke: A clinical research update.

Acute ischemic stroke (AIS) not only affects the brain but also has significant implications for peripheral organs through neuroendocrine regulation. This reciprocal relationship influences overall brain function and stroke prognosis. Recent research has highlighted the importance of poststroke liver changes in determining patient outcomes. In our previous study, we investigated the relationship between stroke and liver function. Our findings revealed that the prognostic impact of stress-induced hyperglycemia in patients undergoing acute endovascular treatment for acute large vessel occlusion is closely related to their preexisting diabetes status. We found that the liver contributes to stress hyperglycemia after AIS by increasing hepatic gluconeogenesis and decreasing hepatic insulin sensitivity. These changes are detrimental to the brain, particularly in patients without diabetes. Furthermore, we examined the role of bilirubin, a byproduct of hepatic hemoglobin metabolism, in stroke pathophysiology. Our results demonstrated that blood bilirubin levels can serve as predictors of stroke severity and may hold therapeutic potential for reducing oxidative stress-induced stroke injury in patients with mild stroke. These results underscore the potential role of the liver in the oxidative stress response following AIS, paving the way for further investigation into liver-targeted therapeutic strategies to improve stroke prognosis and patient outcomes.

321: OUTPATIENT DIABETES MANAGEMENT INFLUENCES GLYCEMIC CONTROL IN ICU PATIENTS DURING NUTRITION SUPPORT

Introduction: Appropriate glycemic control improves clinical outcomes during critical illness. We proposed that outpatient diabetes management would influence glycemic control in critically ill patients who require nutrition support (NS). Methods: Adult patients admitted to the trauma intensive care unit (ICU), who required NS, and exhibited hyperglycemia (blood glucose concentration (BG) > 150 mg/dL) or had diabetes mellitus (DM), were retrospectively evaluated. Outpatient DM pharmacotherapy was discontinued upon ICU admission. NS was initiated on day 3 + 3 following ICU admission. A serum hemoglobin (Hgb) A1c was obtained on day 3 + 3. The daily amount/mode of insulin therapy, carbohydrate intake, and point of care BGs for the first 7 days of NS were recorded. Patients were classified as controlled DM (Hgb A1c < 7%), uncontrolled DM (Hgb A1c >/= 7%), or as hyperglycemic patients without DM (Hgb A1c < 6.5%). Target BG was 70 to 150 mg/dL. Hypoglycemia was defined as a BG < 70 mg/dL. Regular human insulin sliding scale (SSI), subcutaneous NPH insulin with concurrent SSI, or continuous intravenous insulin infusion (CIVI) were used for glycemic control at the discretion of the NS service or primary service. Continuous data were given as mean + S.D. Chi-square analysis or ANOVA were used to compare groups. Results: Seventy-eight (14 controlled DM, 21 uncontrolled DM, and 43 non-DM) patients were studied. Maximum BG prior to initiation of NS was significantly different between groups (201 + 54 vs. 334 + 192 vs. 191 + 57 mg/dL, respectively, P < 0.001). The proportion of patients who required higher intensity insulin therapy (NPH + SSI or CIVI) was different among groups (50% vs. 86% vs. 15%, respectively, P < 0.001). The amount of insulin given per gram of carbohydrate intake was 0.45 + 0.50, 1.24 + 1.21, and 0.15 + 0.21 units/g, respectively, P < 0.001. Time within the target BG range was 11 + 6, 12 + 5, and 17 + 6 hrs/day, respectively, P < 0.001. Hypoglycemia occurred in 1 (7%), 5 (24%), and 3 (7%) patients, respectively (P = 0.120). Conclusions: Glycemic control during NS in the ICU is more challenging for those patients whose outpatient DM was uncontrolled compared to those with controlled DM and those with stress-induced hyperglycemia without DM.

Mini review

The impact of stroke, currently the second leading cause of death worldwide, continues to worsen, and even those that survive can have persistent neurological deficits. A potentially significant implication may be due to hyperglycemia, found in one-third of all acute ischemic stroke (AIS) patients. However, prior studies reported conflicting information about the impact of hyperglycemia on poststroke prognosis, likely due to different measurements of stress-induced hyperglycemia. The glucose-to-glycated hemoglobin ratio is an index of stress-induced hyperglycemia after AIS that better quantifies acute changes in blood glucose, as opposed to absolute variations in glucose levels. Moderate blood glucose reductions might counteract the negative effects of hyperglycemia and glycemic control medications can also play a role in neuroprotection. The liver is the main organ that functions to maintain energy and glucose metabolism and the effects of AIS can reach far peripheral organs, including the liver. In this review, we highlighted the mechanism responsible for acute poststroke hyperglycemia, a hepatic inflammatory pathway that results in hepatic gluconeogenesis and reduced hepatic insulin sensitivity. Hepatitis cascades lead to hepatic gluconeogenesis, and targeted therapy with antihyperglycemic drugs has the potential to improve stroke prognosis and recovery.

HYPOGLYCEMIC ACTIVITY OF $ORIGANUM~VULGARE$ L. AQUEOUS EXTRACT IN HYPERGLYCEMIA INDUCED BY IMMOBILIZATION STRESS IN RABBITS

Currently diabetes mellitus (DM) is a worldwide problem linked to hyper-glyce¬mia and has affected people both in developing and developed countries. DM is divided into Type 1 (T1DM) and Type 2 (T2DM). Moreover, the T2DM is the most prevalence form that encompasses a reduce responsiveness to insulin-sensitive cells or defects in insulin secretion. Exposure to chronic immobilization stress contributes to the development of hyperglycemia and hyperlipidemia that can lead to cardiovascular complications. Herbs with hypoglycemic properties, especially Origanum vulgare L., would be useful in hyperglycemia treatment. Oral administration of aqueous extract showed significant effect on hyperglycemia and improving glucose tolerance. In addition, extract of O. vulgare reduced total cholesterol, low-density lipoprotein cholesterol levels, and vice versa increased high-density lipoprotein cholesterol levels, and also decreased liver enzymes levels (alanine aminotransferase and aspartate aminotransferase) compared with untreated group and might be recommended as herbal remedy in the treatment of stress-induced hyperglycemia.

Quantification of stress-induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio.

Stress-induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A1c (HbA1c ). We identified eligible patients for eight medical (n= 892) and eight surgical (n= 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR. Analysis of variance indicated differing SHR and BG within both the medical (p< 0.0001 for both) and surgical cohort (p< 0.0001 for both). Diagnostic categories were associated with signature levels of SHR that varied between groups. Medically, SHR was greatest for ST-elevation myocardial infarction (1.22 ± 0.33) and sepsis (1.37 ± 0.43). Surgically, SHR was greatest for colectomy (1.62 ± 0.48) and cardiac surgeries (coronary artery graft 1.56 ± 0.43, aortic valve replacement 1.71 ± 0.33, and mitral valve replacement 1.75 ± 0.34). SHR values remained independent of HbA1c , with no difference for those with HbA1c above or below 6.5% (p> 0.11 for each). BG however was highly dependent on HbA1c , invariably elevated in those with HbA1c ≥ 6.5% (p < 0.001 for each), and unreliably reflected SIH. The acute stress response associated with various medical and surgical categories is associated with signature levels of SIH. Those with higher expected SHR are more likely to benefit from early SIH management, especially major surgery, which induced SIH typically 40% greater than medical cohorts. SHR equally recognised the acute change in BG from baseline across the full HbA1c spectrum while BG did not and poorly reflected SIH.

Evaluation of Blood Glucose Levels of COVID-19 Patients before and after Recovery Regardless of Their Diabetic Status

Background: Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. Stress-induced hyperglycemia is well-known as an adaptive response and expected during times of infection. However, this is believed to be a transient response that resolves upon the improvement of the infection. Aim: The aim of this study is to evaluate the blood glucose levels in a cohort of COVID-19 patients to determine their hyperglycemic status before and after the recovery regardless of their diabetic status. Methodology: This is a multicenter, retrospective, observational study. A detailed case history including investigations and laboratory findings was taken from the recovered COVID-19 patients. Data of their random blood sugar levels before and after COVID-19 recovery were collected and compared to check for their hyperglycemic status after the recovery. Data were then tabulated in the spreadsheet and statistical analysis was done. Results: In our study, we compared the hyperglycemic status after the recovery. About 22.1% had hyperglycemia post-COVID. During COVID, the prevalence of hyperglycemia in patients was 23% with or without a previous history of diabetes. Altogether, there was a significant increase in Blood Glucose levels post-COVID (2-month follow-up) period. A significant P (P = 0.0001) was found in the statistical analysis. Conclusion: Clinicians must recognize that some patients may require monitoring the glycemic status and intensification of the antihyperglycemics for several weeks to months after infection devoid of their diabetic status.

Stress-Induced Hyperglycemia: Consequences and Management.

Hyperglycemia during stress is a common occurrence seen in patients admitted to the hospital. It is defined as a blood glucose level above 180mg/dl in patients without pre-existing diabetes. Stress-induced hyperglycemia (SIH) occurs due to an illness that leads to insulin resistance and decreased insulin secretion. Such a mechanism causes elevated blood glucose and produces a complex state to manage with external insulin. This article compiles various studies to explain the development and consequences of SIH in the critically ill that ultimately lead to an increase in mortality while also discussing the dire impact of SIH on certain acute illnesses like myocardial infarction and ischemic stroke. It also evaluates multiple studies to understand the management of SIH with insulin and proper nutritional therapy in the hospitalized patients admitted to the Intensive care unit (ICU) alongside the non-critical care unit. While emphasizing the diverse effects of improper control of SIH in the hospital, this article elucidates and discusses the importance of formulating a discharge plan due to an increased risk of type 2 diabetes in the recovered.

Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline.

Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management. To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia. A multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. The panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes. The recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population.