High Blood Sugar Puts Intensive-Care Patients at Higher Risk

CINCINNATI—High blood sugar even in non-diabetic patients is associated with increased death in intensive care units, according to researchers at the Veterans Affairs Inpatient Evaluation Center located at the Cincinnati VA and the University of Cincinnati (UC).

The findings will be presented today at the American Diabetes Association’s 66^th annual scientific sessions (June 9–13).

“Our finding that mortality risk varied depending on the disease that led to a patient’s hospitalization was consistent with our expectations,” says Mercedes Falciglia, MD, assistant professor of medicine at UC and staff endocrinologist at the Cincinnati VA.

“But what did surprise us is that intensive-care patients with high blood sugar (hyperglycemia) who had no diagnosis of diabetes were more likely to die than patients with diagnosed diabetes and the same degree of elevated blood sugar.”

Researchers at the VA Inpatient Evaluation Center examined the records of 216,000 critically ill patients, 97 percent of whom were male, admitted at 177 VA intensive-care units throughout the country. They found patients with certain diseases and conditions, especially cardiovascular problems such as heart attack and stroke, faced a significantly higher risk of dying.

Hyperglycemia increased heart attack patients’ risk of death from up to five times that expected among non-hyperglycemic patients of similar age and with similar associated illnesses. Hyperglycemia raised the death risk of stroke patients anywhere from 3.4 to 15.1 times, and that of unstable angina patients from 1.7 to 6.2 times.

Early, small trials have already associated hyperglycemia with increased mortality in hospitalized patients. However, the potential benefits of reducing high blood sugar levels have been questioned, because results from intervention trials with intensive insulin therapy have varied—some trials showing improved outcomes with treatment and others having no effect.

“It’s not clear why hyperglycemia occurs in hospitalized patients who don’t have diagnosed diabetes, nor why they may have worse outcomes in some cases than people with diagnosed diabetes,” says Falciglia. “That’s why further studies are necessary.”

According to Falciglia, intensive-care personnel routinely obtain blood for various tests, including blood sugar levels.

“For many of the conditions typically found in the ICU setting it’s important that someone look at the patient’s blood sugar level information and act on it,” says Falciglia. “Physicians are increasing their awareness of the potential harm from hyperglycemia and a systematic approach for lowering sugar levels in hospitalized patients is important in order to do so effectively and safely. The good news is that such initiatives are becoming a priority throughout the country.”

Locally, Falciglia is leading a team of physicians, nurses and pharmacists from UC and University Hospital who have established DiabetesNow!, a new program providing cutting-edge resources and education for practitioners caring for diabetes and hyperglycemia inpatients. The program offers intensive practitioner education and a protocol on insulin use, and establishes diabetes resource specialists for every unit in the hospital.

Collaborators in the study were Marta Render, MD, professor of pulmonary and critical care and director of the VA’s Inpatient Evaluation Center, and David D’Alessio, MD, professor and division director of endocrinology. The research was funded by the VA.

The American Diabetes Association estimates that 6.2 million Americans have undiagnosed diabetes. Caused by high blood sugar levels resulting from the body’s inability to produce or use insulin, diabetes affects 20.8 million children and adults in the United States and is the fifth leading cause of death by disease.