Stress hyperglycemia [inpatient hyperglycemia in patients without known diabetes (DM) ] is associated with poor outcomes, but not well characterized. To fill this gap in knowledge, we evaluated a retrospective national cohort of 240,047 Veterans, hospitalized ≥3d in 2002-14, with regular care before/after admission, and without pre-admission (preAdm) DM [defined by ICD code + DM Rx use, or A1c ≥6.5% or random plasma glucose (RPG) ≥200 mg/dl) . Mean age was 74 yr and BMI 28 kg/m2; 96% were male; 76% white, 16% black. Inpatient RPG was analyzed as ordinal mg/dl categories of the second highest inpatient RPG (iRPG) . We found that 44% had iRPG ≤1mg/dl, 37% had iRPG 111-140 mg/dl, and 19% had ≥ 141 mg/dl. Demographic factors were not clinically different between iRPG groups, but those with second highest preAdm RPG (paRPG) ≥115 mg/dl were more likely to have iRPG ≥140 mg/dl than those with paRPG ≤1mg/dl (26% vs. 16%, p<0.001) . The prevalence of inpatient composite cardiovascular disease (CVD) and organ damage (acute MI, acute kidney injury, acute respiratory failure) , but not infection, increased with higher iRPG (CVD: OR 1.for iRPG 140-149 mg/dl and OR 1.62 for iRPG ≥200 mg/dl; organ damage: OR 1.and 1.96, respectively, p<0.001, compared to iRPG ≤1mg/dl, adjusted for demographics, Elixhauser score, glucocorticoid use) . The prevalence of inpatient critical illness and incident DM post-discharge also rose with iRPG, (critical illness: OR 1.15 for iRPG 110-1 and OR 4.for iRPG ≥200 mg/dl; 3 yr incident DM: OR 1.81 and 11.06, respectively, p<0.001) . iRPG >140 mg/dl was associated with 9.6% 3yr DM incidence. Compared to those without incident DM, the incident DM group had a 21 mg/dl higher mean iRPG (p <0.001) and more CVD at lower iRPGs (38% CVD for iRPG ≤120 vs. 29%) . Conclusion: Stress hyperglycemia is associated with inpatient CVD, critical illness and organ damage, as well as incident DM post-discharge. Moreover, iRPG >140 mg/dl identifies high risk patients for DM who should undergoing close screening.


M.Sukkari: None. S.Fang: None. S.Aiyedipe: None. A.Khakharia: None. K.A.Easley: None. L.S.Phillips: Other Relationship; Cystic Fibrosis Foundation, Diasyst Inc., Research Support; Abbott Diabetes, AbbVie Inc., Janssen Pharmaceuticals, Inc., Janssen Scientific Affairs, LLC, Pfizer Inc. M.K.Rhee: Research Support; Kowa Company, Ltd.

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