Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia

Mikkel Thor Olsen, Arnold Matovu Dungu, Carina Kirstine Klarskov, Andreas Kryger Jensen, Birgitte Lindegaard, Peter Lommer Kristensen, Mikkel Thor Olsen, Arnold Matovu Dungu, Carina Kirstine Klarskov, Andreas Kryger Jensen, Birgitte Lindegaard, Peter Lommer Kristensen

Abstract

Background: Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV.

Methods: This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible.

Results: Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P < 0.01), and by a factor of 1.42 (1.04 to 1.97) in patients treated with GCs but without T2DM during the daytime (P = 0.031) compared to patients without T2DM and not treated with GCs. CV (95%CI) increased by 5.1 (0.0 to 10.1) and 8.1 (1.0 to 15.2) percentage points during the daytime and the nighttime, respectively, in patients with T2DM and not treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.046 and P = 0.026, respectively). PPGE (95% CI) increased during lunch by 2.5 (0.7 to 4.3) mmol/L (45 (13 to 77) mg/dL) in patients with T2DM and treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.018).

Conclusions: CAP patients receiving GCs, especially those with T2DM, are at great risk of developing high GV and therefore require clinical attention to mitigate GV. This applies particularly during the daytime. Results support the 1 to 2-h post-lunch screening procedure for glucocorticoid-induced hyperglycemia in patients without diabetes. SD was positively correlated with hospital length of stay.

Keywords: Chronic obstructive pulmonary disease; Community-acquired pneumonia; Continuous glucose monitoring; Diabetes mellitus; Glucocorticoid-induced hyperglycemia; Glycemic variability; Length of stay.

Conflict of interest statement

MTO: None, AMD: None, CK: None, AKJ: None, BL: None, PLK: Has received speakers fee from Sanofi A/S, Novo Nordisk A/S, Boehringer Ingelheim A/S and AstraZeneca A/S.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Prediction of length of stay at group levels. Dots depict the predicted (Model 1) length of stay for Groups 1 to 4. Lines depict the 95% CI

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