Mendez Carlos E, Mok Ki-Tae, Ata Ashar, Tanenberg Robert J, Calles-Escandon Jorge, Umpierrez Guillermo E
Corresponding author: Carlos E. Mendez,
Diabetes Care. 2013 Dec;36(12):4091-7. doi: 10.2337/dc12-2430. Epub 2013 Oct 29.
To investigate the association between glycemic variability (GV) and both length of stay (LOS) and 90-day mortality in noncritically ill hospitalized patients.
This study retrospectively analyzed 4,262 admissions to the general medicine or surgery services during a 2 year period. Patients with point-of-care glucose monitoring and a minimum of two glucose values per day on average were selected. GV was assessed by SD and coefficient of variation (CV). Data were analyzed with linear and logistic multivariate regression analysis in separate models for SD and CV. Analysis was performed with generalized estimating equations to adjust for correlation between multiple admissions in some individual cases.
After exclusions, 935 admissions comprised the sample. Results of adjusted analysis indicate that for every 10 mg/dL increase in SD and 10-percentage point increase in CV, LOS increased by 4.4 and 9.7%, respectively. Relative risk of death in 90 days also increased by 8% for every 10-mg/dL increase in SD. These associations were independent of age, race, service of care (medicine or surgery), previous diagnosis of diabetes, HbA1c, BMI, the use of regular insulin as a sole regimen, mean glucose, and hypoglycemia occurrence during the hospitalization.
Our results indicate that increased GV during hospitalization is independently associated with longer LOS and increased mortality in noncritically ill patients. Prospective studies with continuous glucose monitoring are necessary to investigate this association thoroughly and to generate therapeutic strategies targeted at decreasing GV.
探讨血糖变异性（GV）与非危重症住院患者住院时间（LOS）及90天死亡率之间的关联。
本研究回顾性分析了2年期间普通内科或外科服务的4262例入院病例。选择进行即时血糖监测且平均每天至少有两个血糖值的患者。通过标准差（SD）和变异系数（CV）评估GV。在针对SD和CV的单独模型中，采用线性和逻辑多变量回归分析对数据进行分析。使用广义估计方程进行分析，以调整某些个体病例中多次入院之间的相关性。
排除后，935例入院病例构成样本。调整分析结果表明，SD每增加10mg/dL以及CV每增加10个百分点，住院时间分别增加4.4%和9.7%。SD每增加10mg/dL，90天内的死亡相对风险也增加8%。这些关联独立于年龄、种族、护理科室（内科或外科）、既往糖尿病诊断、糖化血红蛋白（HbA1c）、体重指数（BMI）、仅使用常规胰岛素治疗方案、平均血糖以及住院期间低血糖的发生情况。
我们的结果表明，住院期间GV升高与非危重症患者住院时间延长和死亡率增加独立相关。有必要进行连续血糖监测的前瞻性研究，以全面调查这种关联并制定旨在降低GV的治疗策略。
