171-LB: Stress Hyperglycemia Is Associated with Higher Preadmission Glucose and Post-Discharge Diabetes Incidence

Stress hyperglycemia is associated with worse outcomes, but its associated risks and contributors are not well known. We evaluated characteristics associated with high inpatient random plasma glucose levels (RPG) in a retrospective cohort of the national VA Health Care System. Patients were age ≥18 yrs, without diagnosed diabetes (DM), hospitalized ≥3 days in 2002-2014 with ≥2 RPGs, and had regular care ≥2 yrs before and ≥3 yrs after hospitalization. In 205,270 pts, mean age was 73.8 yrs and BMI 28.0 kg/m²; 96% were male, 75% white, 16% black. Second highest inpatient RPG levels (iRPG-2max) of <130, 130-139, 140-159, 160-179, 180-199, and ≥200 mg/dl were found in 63%, 10%, 13%, 6%, 3%, and 4% of patients, respectively, without demographic differences between groups. Those with higher iRPG-2max had longer lengths of stay (LOS; median 5 days with <130 mg/dl vs. 10 days with ≥200, p<0.001), and higher rates of acute kidney injury (AKI; 9.3% with <130 vs. 29.3% with ≥200 group; OR 3.8, 95% CI 3.6-4.0) but no differences in rates of infection. Before admission, higher iRPG-2max groups were more likely to have ≥2 outpatient RPGs (oRPG) ≥130 mg/dl (7.2% with <130 mg/dl vs. 15.2% with ≥200, p<0.001). After discharge, higher iRPG-2max groups had more incident DM within 1 and 3 yrs (1.3% and 3.4%, respectively, with <130 vs. 14.9% and 18.4% with ≥200, both p<0.001). In multivariate analysis, higher iRPG-2max was more likely with oRPG ≥130 mg/dl vs. oRPG <110 (adj OR 1.81, 95% CI 1.75-1.87), and with DM in 3 yrs post-discharge vs. no DM (adj OR 2.52, 95% CI 2.49-2.70).

Conclusion: Patients with outpatient random plasma glucose (RPG) ≥130 mg/dl have a higher risk of stress hyperglycemia, which is associated with longer length of stay, more acute kidney injury, and higher incidence of diabetes after discharge. Thus, patients with ≥2 pre-admission RPGs ≥130 should have inpatient RPGs monitored carefully, and those with high inpatient RPGs should be screened for diabetes for up to 3 years after discharge.