Glycemic gap increases mortality risk in critically ill diabetes patients: Study

China: An article published in the Journal of Intensive Care Medicine states that Glycemic Gap is independently associated with an increased risk of mortality in critically ill diabetic patients. ICU mortality outcomes can be improved by controlling and maintaining blood glucose levels close to outpatient/baseline levels.

A glycemic gap is a marker of glycemic excursion in patients with diabetes admitted to ICU and can be used to predict adverse outcomes in such patients.Dysglycemia( any abnormalities in blood glucose levels) is associated with poor outcomes in critically ill patients but this is uncertain in diabetic patients in regards to glucose control before hospitalization.

A research team consisting of Ran Lou, Xuanwu Hospital Capital Medical University, China, and colleagues investigated the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU on the outcomes of critically ill patients with diabetes.

431 patients were included in this retrospective observational cohort study that evaluated the impact of glycemic control in the critical care setting compared with baseline control and its impact on mortality. Patients were divided into survival groups and nonsurvival groups according to survival or not at 28-day, and the relationship between GAP and mortality was analyzed.

The glycemic gap means (GAPmean) was calculated as the mean glucose level within the first 7 days after admission to the ICU compared with A1c-derived average glucose (ADAG), and the glycemic gap-admission (GAPadm) was calculated as the difference between admission blood glucose and ADAG.

Study results showed that,

• Both the groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAPadm, GAPmean, and higher MH(moderate hypoglycemia) and SH(severe hypoglycemia) incidences.

• The nonsurvival group showed less duration of ventilator-free, non-ICU stay and a longer duration of renal replacement therapy(RRT)

• GAPmean had the greatest predictive power with an AUC of 0.807 and the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%).

• The AUC was increased to 0.852 incorporated with SOFA5 (NRI  =  11.34%).

Researchers concluded that glycemic GAP between the MGL within 5 days and ADAG was independently associated with a 28-day mortality of critically ill diabetic patients. Moreover, its predictive capability was maximized with the addition of the Sequential Organ Failure Assessment (SOFA).

Reference:

Lou R, Jiang L, Wang M, Zhu B, Jiang Q, Wang P. Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes. Journal of Intensive Care Medicine. May 2022. doi:10.1177/08850666221101856