Document Detail


The effect of glycaemic control and glycaemic variability on mortality in patients hospitalized with congestive heart failure.
MedLine Citation:
PMID:  21218512     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: diabetes and CHF are common comorbidities in hospitalized patients but the relationship between glycaemic control, glycaemic variability, and mortality in patients with both conditions is unclear.
METHODS: we used administrative data to retrospectively identify patients with a diagnosis of CHF who underwent frequent glucose assessments. TWMG was compared with other measures of glycaemic control and a time-weighted measure of glycaemic variability, the glycaemic lability index. The outcome was hospital mortality.
RESULTS: a total of 748 patients were included in the final analysis. Time-weighted mean glucose was higher than unadjusted mean glucose (137 + /- 44.7 mg/dL versus 167 + /- 54.9, p < 0.001), due in part to shorter sampling intervals at higher glucose levels. Hypoglycaemia, defined as a glucose level < 70 mg/dL, occurred during 6.3% of patient-days in survivors and 8.4% of patient-days among nonsurvivors (p = 0.05). Time-weighted mean glucose was similar (128 + /- 33.1 mg/dL versus 138 + /- 45.1 mg/dL) in nonsurvivors versus survivors, p = 0.19). However, relatively few patients had were significantly elevated readings. Median GLI was higher in nonsurvivors compared with that in survivors (18.1 versus 6.82, p = 0.0003). Increasing glycaemic lability index (odds ratio 1.32, 95% confidence interval 1.05-1.65), and hypoglycaemia (odds ratio 2.21, 95% confidence interval 1.07-4.65), were independently associated with higher mortality in logistic regression analysis. Respiratory failure was associated with mortality, but not standard deviation of glucose.
CONCLUSIONS: future studies analysing glycaemic control should control for variable sampling intervals. In this analysis, glycaemic lability index was independently associated with increased mortality, independent of hypoglycaemia. Prospective studies are needed to evaluate these findings.
Authors:
Kathleen M Dungan; Philip Binkley; Haikady N Nagaraja; Dara Schuster; Kwame Osei
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetes/metabolism research and reviews     Volume:  27     ISSN:  1520-7560     ISO Abbreviation:  Diabetes Metab. Res. Rev.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-10     Completed Date:  2011-04-28     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  100883450     Medline TA:  Diabetes Metab Res Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  85-93     Citation Subset:  IM    
Copyright Information:
2010 John Wiley & Sons, Ltd.
Affiliation:
Division of Endocrinology, Department of Internal Medicine, Diabetes & Metabolism, Ohio State University, Columbus, OH 43210-1296, USA. Kathleen.dungan@osumc.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Blood Glucose / metabolism*
Comorbidity
Diabetes Mellitus, Type 2 / etiology,  metabolism,  mortality*
Female
Glycemic Index
Heart Failure / complications,  metabolism,  mortality*
Hospitalization / statistics & numerical data*
Humans
Male
Retrospective Studies
Survival Rate
Grant Support
ID/Acronym/Agency:
1K23DK080891-02/DK/NIDDK NIH HHS; K23 DK080891-02/DK/NIDDK NIH HHS; K23 DK080891-04/DK/NIDDK NIH HHS; UL1 RR025755/RR/NCRR NIH HHS; UL1RR025755/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Blood Glucose
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Contribution of postprandial glucose to excess hyperglycaemia in Asian type 2 diabetic patients usin...
Next Document:  Acute hypoxia and exercise improve insulin sensitivity (S(I) (2*)) in individuals with type 2 diabet...