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The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 3 1402
Copyright © 2003 by The Endocrine Society

Letter to the Editor

Authors’ Response: Hyperglycemia—An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes

Guillermo E. Umpierrez and Abbas E. Kitabchi

University of Tennessee Health Science Center Memphis, Tennessee 38163

Address correspondence to: Guillermo E. Umpierrez, M.D., Associate Professor of Medicine, Division of Endocrinology and Metabolism, University of Tennessee Health Science Center, 951 Court Avenue, Room 340M, Memphis, Tennessee 38163. E-mail: gumpierrez{at}utmem.edu.

To the editor:

We appreciate the interest of Dr. Cakir and colleagues in our recent publication regarding in-patient hyperglycemia. Several observational studies have shown that admission hyperglycemia in patients without diabetes is associated with increased morbidity and mortality during critical illnesses (1, 2, 3, 4, 5). Similarly, several intervention studies in acutely ill patients have shown that control of hyperglycemia significantly reduces the rate of complications and risk of death (6, 7, 8). This evidence strongly suggests that hyperglycemia is associated with adverse outcomes for hospitalized patients with and without diabetes and that improvement in outcome can be achieved with improved glycemic control (9). The major findings of our study are that hyperglycemia was present in 38% of patients admitted to the hospital, of whom one third had no history of diabetes before the admission, and that newly discovered hyperglycemia was associated with higher in-hospital mortality rate and lower functional outcome not only in critically ill patients admitted to the Intensive Care Unit (ICU) but also in patients admitted to general medicine or surgical wards. We agree with Dr. Cakir's comments that a number of features suggest that patients with new hyperglycemia are under more severe stress and had a more severe illness as indicated by a higher rate of ICU admission, a longer length of hospital stay, and the increased referral rate to an extended care facility after discharge. Further research should focus on the optimal management of hyperglycemia in patients admitted to both the ICU and the general medicine and surgical wards.

Received November 4, 2002.

References

  1. Capes SE, Hunt D, Malmberg K, Gerstein HC 2000 Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 355:773–778[CrossRef][Medline]
  2. Fava S, Aquilina O, Azzopardi J, Agius Muscat H, Fenech FF 1996 The prognostic value of blood glucose in diabetic patients with acute myocardial infarction. Diabetes Med 13:80–83[CrossRef][Medline]
  3. Norhammar AM, Ryden L, Malmberg K 1999 Admission plasma glucose: independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care 22:1827–1831[Abstract/Free Full Text]
  4. Capes SE, Hunt D, Malmberg K, Pathak P, Gersyein HC 2001 Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32:2425–2432
  5. Weir CJ, Murray GD, Dyker AG, Lees KR 1997 Is hyperglycemia an independent predictor of poor outcome after acute stroke? Results from a long term follow up study. BMJ 314:1303–1306[Abstract/Free Full Text]
  6. 1993 Preoperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 325:525–532
  7. Malmberg K 1997 Prospective randomised study of intensive insulin treatment on long-term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515[Abstract/Free Full Text]
  8. Van den Berghe G, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R 2001 Intensive insulin therapy in the surgical intensive care unit. N Engl J Med 345:1359–1367[Abstract/Free Full Text]
  9. Montori VM, Bistrian BR, McMahon MM 2002 Hyperglycemia in acutely ill patients. JAMA 288:2167–2169[Free Full Text]




This Article
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