Background: Experimental studies have shown that an increase in serum osmolality (Osm) of even 10 mOsm/kg significantly contributes to progressive hyperglycemia by increasing hepatic glucose output and suppressing peripheral glucose utilization. The Osm increases parallel to the increase in blood glucose (BG) and vice versa. This is not therapeutically exploited yet.

Aim: To assess the effect of pre-treatment with IV 0.9% saline (NS) on glycemic control and medication requirement in type 2 diabetes mellitus (T2DM) patients presenting with subcritical hyperglycemia (SCH) -hyperglycemia not amounting to DKA or HHS.

Method: A retrospective comparative data analysis of T2DM patients (198) with SCH, pre-treated with NS before diabetic specific therapy (group 1) and compared with those who were not pre-treated with NS (group 2). Differences in glycemic control and drug dosage were assessed.

Results: In group 1, 1500ml of NS administration reduced the BG from a baseline of 496.3±67.1 to 283.3±83.8 (mg/dL), p=0.000 with a mean reduction of 43% and reduced the Osm by 11mOsm/kg [313.8±8.1 to 302.9±8.5, p<0.001]. There was a significant correlation between BG and Osm (r=0.322, p=0.001). Fluid pre-treatment enabled a better reduction in BG during 4 weeks of follow up in group 1{[FBS- 298.9±73.7 to 158.9±58.7 in group 1 v/s 265.6±70.7 to 171.48±66.5 in group 2, p=0.00] and [RBS- 496.3±67.1 to 228.3±80.7 in group 1 v/s 450.5±47 to 282±112.4 in group 2, p=0.001]}. There was a general trend of decrease in the dosages of antidiabetic medications in group 1 and increase of the same in group 2.

Conclusions: IV fluid pre-treatment reduced the BG and the drug dosage in T2DM patients presenting with SCH and the benefit persisted for a minimum of 4 weeks.


P. Sureshkumar: None.

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