None listed
Conditions
Brief summary
Hyperglycaemia in hospitalised patients is independently associated with increased morbidity and mortality in a wide range of patient groups, including post-operative outcomes. The association between hyperglycaemia and poor outcomes is strong in patients without diabetes, but a weaker predictor in patients with diabetes. This discrepancy is in part driven by the difficulty in distinguishing genuine stress hyperglycaemia from chronic high levels seen in diabetic patients. A high plasma glucose concentration in a hospitalised patient can occur because of chronic poor diabetes control and be “normal” for that patient, represent a transient physiologic response to an inter¬current illness (stress hyperglycaemia), or be a combination of the above. A metric for stress hyperglycaemia has been developed at Flinders Medical Centre - the Stress Hyperglycaemia Ratio is defined as glucose concentration divided by the Estimated Average Glucose concentration, which is calculated from HbA1c. This enables quantification of the relative change in hyperglycaemia eg a patient with a SHR of 1.4 has an glucose concentration 40% higher than their average glucose over the prior 3 months. Our previous work indicated that the relative change in glucose was a better indicator of stress hyperglycaemia and more strongly associated with adverse patient outcomes than glucose. This initial work needs to be confirmed in a further population of hospitalised patients. We also aim to study some specific subgroups of interest, namely infections (both at admission and those that develop during the admission), and events related to blood clots (heart attacks, stroke, deep vein thromboses, and pulmonary emboli). This will enable us to determine those patients who might benefit most from early management of elevated glucose levels due to stress hyperglycaemia.
Interventions
The association of stress hyperglycaemia with adverse outcomes associated with hospitalisations will be determined using admission glucose level, and the relative change in glucose at admission as determined by the Stress Hyperglycaemia Ratio. SHR is defined by glucose value closest to the time of admission divided by the estimated average glycaemia ( as calculated from the HbA1c using the formula developed by Nathan et al. Diab Care 2008;31:1473–14788. An adverse outcome is in-hospital death or
The association of stress hyperglycaemia with adverse outcomes associated with hospitalisations will be determined using admission glucose level, and the relative change in glucose at admission as determined by the Stress Hyperglycaemia Ratio. SHR is defined by glucose value closest to the time of admission divided by the estimated average glycaemia ( as calculated from the HbA1c using the formula developed by Nathan et al. Diab Care 2008;31:1473–14788. An adverse outcome is in-hospital death or the acute need for critical care, with patients being observed for the duration of the inpatient admission for the main endpoint, and up to 30 days post-discharge for the secondary endpoints. The strength of association of adverse outcomes will be compared in a multivariable model using admission glucose and admission Stress Hyperglycaemia Ratio, along with other variables known to impact outcomes.
Sponsors
Flinders Medical Centre
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inpatient admission
Exclusion criteria
<18 years age, admissions for psychiatric illness, obstetrics, gynaecology, specific management of blood glucose eg diabetic ketoacidosis, overdose, poisoning, dialysis, non-acute admissions for respite, chemotherapy, patients requiring routine post-op care in ICU.
Outcome results
None listed