Visual Abstract
Objective: The impact of preadmission insulin treatment on the interactions of chronic glycemia, reflected by admission A1c levels, glucose control during critical illness, and mortality is unknown.
Design: This is a retrospective analysis of 1,524 patients with diabetes admitted to the ICU of a university-affiliated teaching hospital, including 538 receiving (INS) and 986 without (NON-INS) insulin treatment prior to admission. Groups were stratified by A1c level: < 6.5%; 6.5%-7.9% and ≥ 8.0%.
Results: Mean glucose (BG), coefficient of variation (CV) and hypoglycemia (< 70 mg/dL) during ICU admission increased with increasing A1c, (p for trend < 0.0001), and were higher for INS than for NON-INS (all p < 0.05). INS with A1c < 6.5% and mean BG ≥ 180 mg/dL or CV ≥ 30% had lower severity-adjusted mortality (SAM) compared to INS with mean BG 80-140 mg/dL and CV ≤ 30%, (p=0.0058 and < 0.0001 respectively), but NON-INS had higher SAM (p=0.0001 and < 0.0001 respectively). INS and NON-INS with A1c ≥ 8.0% and mean BG ≥ 180 mg/dL had lower SAM compared to those with mean BG 80-140 mg/dL (p<0.0001).
Conclusions: Significant differences were found among patients with diabetes based on insulin treatment status prior to admission regarding ICU glucose control and the relationship of glucose control metrics during ICU stay to mortality. These data support an individualized approach to glucose control in the critically ill.
J. S. Krinsley: None. P. R. Rule: None. J. Preiser: None. G. Roberts: None. S. Chaudry: None. C. Heluey-rodrigues: None. K. Dionne: None. G. E. Umpierrez: Research Support; Self; AstraZeneca, Dexcom, Inc., Novo Nordisk. I. B. Hirsch: Consultant; Self; Abbott Diabetes, Bigfoot Biomedical, Inc., Research Support; Self; Insulet Corporation, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic.
