Van Ackerbroeck Sofie, Schepens Tom, Janssens Karolien, Jorens Philippe G, Verbrugghe Walter, Collet Sandra, Van Hoof Viviane, Van Gaal Luc, De Block Christophe
Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Crit Care. 2015 Oct 2;19:355. doi: 10.1186/s13054-015-1064-9.
Elevated blood glucose levels during intensive care unit (ICU) stay, so-called stress hyperglycaemia (SH), is a common finding. Its relation with a future diabetes risk is unclear. Our objective was to determine the incidence of disturbed glucose metabolism (DGM) post ICU admission and to identify predictors for future diabetes risk with a focus on stress hyperglycaemia.
This single center prospective cohort trial (DIAFIC trial) had a study period between September 2011 and March 2013, with follow-up until December 2013. The setting was a mixed medical/surgical ICU in a tertiary teaching hospital in Belgium. 338 patients without known diabetes mellitus were included for analysis. We assessed the level of glucose metabolism disturbance (as diagnosed with a 75 g oral glucose tolerance test (OGTT) and/or HbA1c level) eight months after ICU admission, and investigated possible predictors including stress hyperglycaemia.
In total 246 patients (73 %) experienced stress hyperglycaemia during the ICU stay. Eight months post-ICU admission, 119 (35 %) subjects had a disturbed glucose metabolism, including 24 (7 %) patients who were diagnosed with diabetes mellitus. A disturbed glucose metabolism tended to be more prevalent in subjects who experienced stress hyperglycaemia during ICU stay as compared to those without stress hyperglycaemia (38 % vs. 28 %, P = 0.065). HbA1c on admission correlated with the degree of stress hyperglycaemia. A diabetes risk score (FINDRISC) (11.0 versus 9.5, P = 0.001), the SAPS3 score (median of 42 in both groups, P = 0.003) and daily caloric intake during ICU stay (197 vs. 222, P = 0.011) were independently associated with a disturbed glucose metabolism.
Stress hyperglycaemia is frequent in non-diabetic patients and predicts a tendency towards disturbances in glucose metabolism and diabetes mellitus. Clinically relevant predictors of elevated risk included a high FINDRISC score and a high SAPS3 score. These predictors can provide an efficient, quick and inexpensive way to identify patients at risk for a disturbed glucose metabolism or diabetes, and could facilitate prevention and early treatment.
At ClinicalTrials.gov NCT02180555 . Registered 1 July, 2014.
在重症监护病房（ICU）住院期间血糖水平升高，即所谓的应激性高血糖（SH），是一种常见现象。其与未来糖尿病风险的关系尚不清楚。我们的目的是确定ICU入院后糖代谢紊乱（DGM）的发生率，并确定未来糖尿病风险的预测因素，重点关注应激性高血糖。
这项单中心前瞻性队列试验（DIAFIC试验）的研究期为2011年9月至2013年3月，随访至2013年12月。研究地点是比利时一家三级教学医院的内科/外科混合ICU。纳入338例无已知糖尿病的患者进行分析。我们在ICU入院八个月后评估糖代谢紊乱水平（通过75克口服葡萄糖耐量试验（OGTT）和/或糖化血红蛋白（HbA1c）水平诊断），并调查包括应激性高血糖在内的可能预测因素。
共有246例患者（73%）在ICU住院期间经历了应激性高血糖。ICU入院八个月后，119例（35%）受试者存在糖代谢紊乱，其中24例（7%）被诊断为糖尿病。与未经历应激性高血糖的受试者相比，在ICU住院期间经历应激性高血糖的受试者中糖代谢紊乱往往更为普遍（38%对28%，P = 0.065）。入院时的HbA1c与应激性高血糖程度相关。糖尿病风险评分（FINDRISC）（11.0对9.5，P = 0.001）、简化急性生理学评分第3版（SAPS3）评分（两组中位数均为42，P = 0.003）以及ICU住院期间的每日热量摄入（197对222，P = 0.011）与糖代谢紊乱独立相关。
应激性高血糖在非糖尿病患者中很常见，并预示着糖代谢紊乱和糖尿病的倾向。风险升高的临床相关预测因素包括高FINDRISC评分和高SAPS3评分。这些预测因素可以提供一种有效、快速且廉价的方法来识别有糖代谢紊乱或糖尿病风险的患者，并有助于预防和早期治疗。
在ClinicalTrials.gov上注册，注册号为NCT02180555。于2014年7月1日注册。
