Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients

Carlos E Mendez, Ki-Tae Mok, Ashar Ata, Robert J Tanenberg, Jorge Calles-Escandon, Guillermo E Umpierrez, Carlos E Mendez, Ki-Tae Mok, Ashar Ata, Robert J Tanenberg, Jorge Calles-Escandon, Guillermo E Umpierrez

Abstract

Objective: To investigate the association between glycemic variability (GV) and both length of stay (LOS) and 90-day mortality in noncritically ill hospitalized patients.

Research design and methods: 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.

Results: 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.

Conclusions: 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.

Figures

Figure 1
Figure 1
A: Mean LOS (days ± SE) and 90-day mortality (% ± SE) of increasing SD tertiles across two MHG categories (90–180 mg/dL and ≥180 mg/dL). B: Mean LOS (days ± SE) and 90-day mortality (% ± SE) of increasing CV tertiles across two MHG categories (90–180 mg/dL and ≥180 mg/dL). For linear trend, P < 0.05 for all series except the 90-day mortality in the MHG ≥180 mg/dL group for SD (P = 0.77) and CV (P = 0.24).

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