Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 4:13:869451.
doi: 10.3389/fendo.2022.869451. eCollection 2022.

Novel Glycemic Index Based on Continuous Glucose Monitoring to Predict Poor Clinical Outcomes in Critically Ill Patients: A Pilot Study

Eun Yeong Ha  1 , Seung Min Chung  1 , Il Rae Park  1 , Yin Young Lee  2 , Eun Young Choi  3 , Jun Sung Moon  1
Affiliations

Novel Glycemic Index Based on Continuous Glucose Monitoring to Predict Poor Clinical Outcomes in Critically Ill Patients: A Pilot Study

Eun Yeong Ha et al. Front Endocrinol (Lausanne). .

Abstract

Aim: We explored the prospective relationship between continuous glucose monitoring (CGM) metrics and clinical outcomes in patients admitted to the intensive care unit (ICU).

Materials and methods: We enrolled critically ill patients admitted to the medical ICU. Patients with an Acute Physiology and Chronic Health Evaluation (APACHE) score ≤9 or ICU stay ≤48 h were excluded. CGM was performed for five days, and standardized CGM metrics were analyzed. The duration of ICU stay and 28-day mortality rate were evaluated as outcomes.

Results: A total of 36 patients were included in this study (age [range], 49-88 years; men, 55.6%). The average APACHE score was 25.4 ± 8.3; 33 (91.7%) patients required ventilator support, and 16 (44.4%) patients had diabetes. The duration of ICU stay showed a positive correlation with the average blood glucose level, glucose management indicator (GMI), time above range, and GMI minus (-) glycated hemoglobin (HbA1c). Eight (22.2%) patients died within 28 days, and their average blood glucose levels, GMI, and GMI-HbA1c were significantly higher than those of survivors (p<0.05). After adjustments for age, sex, presence of diabetes, APACHE score, and dose of steroid administered, the GMI-HbA1c was associated with the risk of longer ICU stay (coefficient=2.34, 95% CI 0.54-4.14, p=0.017) and higher 28-day mortality rate (HR=2.42, 95% CI 1.01-5.76, p=0.046).

Conclusion: The acute glycemic gap, assessed as GMI-HbA1c, is an independent risk factor for longer ICU stay and 28-day mortality rate. In the ICU setting, CGM of critically ill patients might be beneficial, irrespective of the presence of diabetes.

Keywords: blood glucose; diabetes mellitus; glucose; hospitals; intensive care units; technology.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Scatter plot of the relationship between GMI-HbA1c and ICU stay. The correlation coefficients are presented as Spearman’s r.
Figure 2
Figure 2
Difference in GMI-HbA1c between survivors and non-survivors. *p < 0.05, **p < 0.01.
See this image and copyright information in PMC

References

    1. Gunst J, De Bruyn A, Van den Berghe G. Glucose Control in the ICU. Curr Opin Anaesthesiol (2019) 32(2):156–62. doi: 10.1097/ACO.0000000000000706 - DOI - PMC - PubMed
    1. Chang MC, Hwang JM, Jeon JH, Kwak SG, Park D, Moon JS. Fasting Plasma Glucose Level Independently Predicts the Mortality of Patients With Coronavirus Disease 2019 Infection: A Multicenter, Retrospective Cohort Study. Endocrinol Metab (Seoul) (2020) 35(3):595–601. doi: 10.3803/EnM.2020.719 - DOI - PMC - PubMed
    1. Perlman JE, Gooley TA, McNulty B, Meyers J, Hirsch IB. HbA1c and Glucose Management Indicator Discordance: A Real-World Analysis. Diabetes Technol Ther (2021) 23(4):253–8. doi: 10.1089/dia.2020.0501 - DOI - PMC - PubMed
    1. Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF. Mean Amplitude of Glycemic Excursions, a Measure of Diabetic Instability. Diabetes (1970) 19(9):644–55. doi: 10.2337/diab.19.9.644 - DOI - PubMed
    1. McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A Novel Approach to Continuous Glucose Analysis Utilizing Glycemic Variation. Diabetes Technol Ther (2005) 7(2):253–63. doi: 10.1089/dia.2005.7.253 - DOI - PubMed

Publication types