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. 2017 Oct;19(10):572-579.
doi: 10.1089/dia.2017.0107.

High Glucose Variability in Hospitalized Patients with Type 1 Diabetes Mellitus

Vikash Dadlani  1 , Shrikant U Tamhane  1 , Aidong Sun  1 , Anu Sharma  1 , Danae A Delivanis  1 , Prabin Thapa  2 , Ricky E Carter  2 , Yogish C Kudva  1
Affiliations

High Glucose Variability in Hospitalized Patients with Type 1 Diabetes Mellitus

Vikash Dadlani et al. Diabetes Technol Ther. 2017 Oct.

Abstract

Background: Glucose variability (GV) has been increasingly (or more extensively) studied in patients with type 1 diabetes (T1D) in the ambulatory setting; limited data exist on GV in hospitalized patients with T1D.

Materials and methods: Retrospective single center cohort study, we analyzed in-hospital glucose measurements to assess GV in 736 hospitalized patients in different units over a consecutive 5-year period of time. GV was assessed by mean blood glucose (BG), Average daily risk range (ADRR), high BG index, and low BG index. To place our findings in context, we conducted a systematic review using Cochrane collaboration methodology to critically analyze current published literature on GV in hospitalized T1D patients.

Results: Overall, glycemic control was suboptimal with mean BG 183 ± 51.5 mg/dL and mean ADRR 35 with only 16% patients being categorized as low risk (ADRR <20) for hypo or hyperglycemia. Patients admitted in medical units had mean BG of 194.4 ± 42.8 mg/dL (95% CI = 101.2-346.6) and ADRR of 39.4 ± 16 (95% CI = 1.3-118.7), which were higher than the patients admitted in the surgical units (mean BG 168.1 ± 35.7 (95% CI = 74.8-301.8) and mean ADRR (28.8 ± 13.1 [95% CI = 0.3-93.1]). For the systematic review, initial search yielded 2336 studies for screening, however, none of them had data specific for T1D.

Conclusion: GV is high in hospitalized T1D patients admitted at our tertiary care center. Review of the literature shows paucity of data regarding GV in hospitalized patients with T1D.

Keywords: Glucose variability; Hospitalization; Hyperglycemia; Hypoglycemia; Type 1 diabetes.

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Conflict of interest statement

No competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
Glycemic variability indices comparison in hospitalized type 1 diabetes patients in different admitting units (A) comparison between medical and surgical admissions (B) comparison between metabolic (Met) and nonmetabolic (NonMet) admissions (C) comparison between hyperglycemia (Hyper) and hypoglycemia (Hypo) admissions (D) comparison between elective and emergent surgical admissions and (E) comparison between ICU and non-ICU admissions. Data are shown as boxplots consisting of 25th, 50th (median), and 75th percentiles represented as the lower, midline, and top components of the inner box. Whiskers extend to the 1.5xIQR. Points outside the whisker are outliers. P-value is for Wilcoxon rank sum tests. ICU, intensive care unit.
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