Hyperglycemia is associated with adverse outcomes in critically ill surgical patients with increasing recognition that those without preexisting DM (NODM) are more affected. As the brain acts as a major regulator of glucose and exclusively depends on it for its high energy needs, we examined the association between hyperglycemia and outcomes in ICU patients undergoing elective or emergent neurosurgery (NSGY) with and without DM. Patients (N 864) were grouped as NODM, pre-existing DM on (DMTR) and not on medications (DMNT) (NODM 637 DMNT 80 DMTR 147). Postop glucose (BG) and time weighted average BG (TWAg) 24 hours postop, postop length of stay (pLOS), hospitalization cost and adverse outcomes (death, respiratory failure, infection, stroke, MI) were obtained retrospectively from admissions between May 2011 - January 2015. Those in DMTR had higher TWAg than in DMNT and NODM (188 vs. 166, 145 mg/dL p<0.005). After adjustment for demographics, comorbidities and surgical characteristics, NODM patients with hyperglycemia (mean of 2 consecutive BG > 180 mg/dL) had higher costs and pLOS while those in DMTR had lower cost and shorter pLOS. Those in NODM with hyperglycemia had more adverse events than those without; this was not seen in DMNT and DMTR (Figure). We found in NSGY patients, hyperglycemia’s association with adverse events depends on DM status and stresses the need to understand underlying mechanisms.


G. Greco: None. A.J. Moskowitz: None. D.W. Lam: Research Support; Self; Novo Nordisk A/S.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.