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Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes

Akdeniz University, School of Medicine, Division of Endocrinology and Metabolism 07070 Antalya, Turkey

Address correspondence to: Prof. Umit Karayalcin, M.D., Akdeniz University School of Medicine, Division of Endocrinology and Metabolism, 07070 Antalya, Turkey. E-mail: umit{at}med.akdeniz.edu.tr.

To the editor:

We have read the interesting paper "Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes" by Umpierrez et al. (1), which is one of the few studies on this issue conducted on a satisfactory number of patients.

However, in our opinion, to conclude that newly diagnosed hyperglycemia is a "marker" for in-hospital mortality when compared with known diabetes and normoglycemia, a more homogenous patient group had to be evaluated. Comparison of admissions of the patient groups showed that distribution of patients among services on admission were different between the three groups. Although there was not a significant difference of admission rates for medical and surgical departments, Intensive Care Unit (ICU) admission was 29% in new hyperglycemia (P < 0.01 vs. normoglycemic, and P < 0.001 vs. known diabetic patients), 14% in known diabetes (P < 0.01 vs. normoglycemic patients), and 9% in normoglycemia groups. Patients with newly diagnosed hyperglycemia were more likely to be admitted to the ICU, which may explain the higher rate of in-hospital mortality noted in these patients. Hyperglycemia on admission without known diabetes has been investigated as a risk factor for increased mortality in specific patient groups before, and the results were controversial (2, 3, 4). As a result, it may be inappropriate to suggest hyperglycemia as a marker in "all" patient groups with this heterogenous patient population.

Received June 26, 2002.

References

1. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE 2002 Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endoc Metab 87:978–983[Abstract/Free Full Text]
2. Matchar DB, Divine GW, Heyman A, Feussner JR 1992 The influence of hyperglycemia on outcome of cerebral infarction. Ann Intern Med 117:449–456
3. Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Hier DB, Kase CS 1991 Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol 29:658–663[CrossRef][Medline]
4. Szczudlik A, Slowik A, Turaj W, Wyrwicz-Petkow U, Pera J, Dziedzic T, Trabka-Janik E, Iskra T 2001 Transient hyperglycemia in ischemic stroke patients. J Neurol Sci 189:105–111[CrossRef][Medline]

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