Glycemic Variability Independent Predictor of Mortality in Sepsis, Suggests Study
Thailand: A comprehensive new meta-analysis suggests that fluctuations in blood glucose levels, rather than average glucose alone, may play a crucial role in determining outcomes among patients with sepsis.
The study, published in Diabetes/Metabolism Research and Reviews by Gelan Miao from the Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand, and colleagues, found that higher glycaemic variability (GV) is strongly associated with increased short-term mortality in adults with sepsis.
Sepsis is a life-threatening condition marked by dysregulated host responses to infection, often accompanied by profound metabolic disturbances. While hyperglycaemia has long been recognised as a poor prognostic marker in critically ill patients, growing attention has shifted toward glycaemic variability—reflecting rapid and wide swings in blood glucose levels—as a potentially more informative indicator. However, evidence specific to septic patients has remained fragmented. The present systematic review and meta-analysis aimed to clarify the relationship between GV and mortality outcomes in this high-risk population.
The researchers systematically searched six major databases, including PubMed, Embase, Cochrane Library, Scopus, CNKI, and Wanfang, to identify cohort studies that evaluated GV in adult patients with sepsis and reported in-hospital, 28-day, or 30-day mortality. A total of ten studies involving 18,337 patients met the inclusion criteria. Using a random-effects model, the investigators pooled odds ratios to assess mortality risk, while sensitivity analyses were conducted to test the stability of the findings.
The analysis revealed the following findings:
- Patients with high glycaemic variability had nearly twice the risk of death compared with those with more stable blood glucose levels, with this association remaining consistent across studies and showing only moderate heterogeneity.
- When glycaemic variability was evaluated as a continuous measure, all commonly used indices—including coefficient of variation, standard deviation, glycaemic lability index, and mean amplitude of glycaemic excursions—were significantly associated with increased mortality.
- Glycaemic lability index and mean amplitude of glycaemic excursions demonstrated minimal heterogeneity, indicating more consistent and reliable prognostic performance across different clinical settings.
- Elevated glycaemic variability was also linked to longer intensive care unit stays, with affected patients spending nearly one additional day in the ICU on average.
- Sensitivity analyses confirmed the robustness of the findings, with results not driven by any single study.
According to the authors, these findings reinforce the concept that glycaemic variability is an independent predictor of poor outcomes in sepsis, rather than merely a bystander or marker of disease severity. Among the various GV measures, GLI and MAGE appeared to provide the most reliable prognostic information, while the coefficient of variation and standard deviation showed greater inconsistency.
The study highlights the importance of paying closer attention to glucose dynamics in critically ill patients with sepsis. The authors emphasise that standardised methods for assessing GV are required before it can be routinely incorporated into clinical practice. They also call for well-designed prospective studies to determine whether therapeutic strategies aimed at reducing glycaemic variability—beyond controlling mean glucose levels—can translate into improved survival and shorter ICU stays in this vulnerable population.
Reference:
Miao, G., Lu, R., Pipanmekaporn, T., Kacha, S., Supphapipat, A., Phothikun, N., Jewprasertpan, P., & Chittawatanarat, K. (2025). Association Between Blood Glucose Variability and Clinical Outcomes in Patients With Sepsis: A Systematic Review and Meta-Analysis. Diabetes/Metabolism Research and Reviews, 42(1), e70119. https://doi.org/10.1002/dmrr.70119
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