Incidence and predisposing factors for the development of disturbed glucose metabolism and DIabetes mellitus AFter Intensive Care admission: the DIAFIC study

Sofie Van Ackerbroeck, Tom Schepens, Karolien Janssens, Philippe G Jorens, Walter Verbrugghe, Sandra Collet, Viviane Van Hoof, Luc Van Gaal, Christophe De Block, Sofie Van Ackerbroeck, Tom Schepens, Karolien Janssens, Philippe G Jorens, Walter Verbrugghe, Sandra Collet, Viviane Van Hoof, Luc Van Gaal, Christophe De Block

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: At ClinicalTrials.gov NCT02180555 . Registered 1 July, 2014.

Figures

Fig. 1
Fig. 1
Overview of the inclusion process and glucose metabolism status. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2
Fig. 2
Fig. 2
Glucose metabolism status of patients with and without stress hyperglycaemia during ICU admission. OGTT oral glucose tolerance test, IFG impaired fasting glucose, IGT impaired glucose tolerance, DM diabetes mellitus type 2
Fig. 3
Fig. 3
a Correlation between glycated haemoglobin (HbA1c) on admission and need for insulin during ICU admission. b Relation between HbA1c on admission and upon oral glucose tolerance test (OGTT) after 8 months. HbA1c is expressed as percent. Three parallel lines represent the mean and 95 % CI; the fourth and steepest line is a line connecting equal values on the x and y axis. The values that are located under this fourth line have decreased (improved), while those above the line have increased (deteriorated)

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