Hyperglycemia and Cardiovascular Disease in Critically III Patients with Diabetes: Trends from 2002-05 vs. 1996-97

Falciglia, Mercedes; Freyberg, Ron W.; Almenoff, Peter L.; D'Alessio, David A.; Render, Marta L.
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA178
Academic Journal
Numerous studies have shown that hyperglycemia is common in critically ill patients and that it increases mortality risk, particularly in those with cardiovascular disease (CVD). Intervention trials of glucose lowering with intensive insulin therapy in patients hospitalized with CVD have reported reductions in morbidity and mortality. Since publication of these findings, glycemic control has been a focus in critical care. To understand the influence of these data on clinical practice we examined glycemic trends over time. We determined the prevalence of CVD and hyperglycemia in a cohort of 259,040 ICU individuals with and without diabetes hospitalized at 114 geographically diverse VA hospitals from 2002-05, and compared these findings to a similar cohort from 1996-97 of 28,484 individuals. A mean glucose (MG) was calculated for each patient from values measured during ICU stay. Diabetes was defined by ICD.9.CM codes consistent with diabetes mellitus, and CVD was defined by ICD.9.CM codes specific to coronary or cerebrovascular disease. Severe hyperglycemia was defined by MG > 200 mg/dl. Of the 2002-05 cohort, 41% had CVD, of which 37% had coexistent diabetes. Cardiovascular disease was present in 51% of the 1996-97 cohort, of which 34% had coexistent diabetes. Rates of severe hyperglycemia in individuals with CVD and diabetes decreased from 42% in 1996-97 to 22% in 2002-05 while rates of normoglycemia increased from 10% to 16%. For individuals with CVD but without diabetes, rates of severe hyperglycemia decreased from 6% to 5% while rates of normoglycemia improved from 35% to 40%. These findings indicate improvements in glycemic control for ICU patients with CVD, particularly in those with diabetes. Because hyperglycemia appears to be specifically harmful in those hospitalized with CVD, further study is needed to determine if these advances are associated with improved outcomes.


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