Threshold of hyperglycaemia associated with mortality in critically ill patients: a multicentre, prospective, observational study using continuous glucose monitoring

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Abstract

Aims/hypothesis

Continuous glucose monitoring (CGM) provides comprehensive information on the exposure to dysglycaemia. This study aimed to investigate the threshold of hyperglycaemia related to mortality risk in critically ill patients using CGM technology.

Methods

A total of 293 adult critically ill patients admitted to intensive care units of five medical centres were prospectively included between May 2020 and November 2021. Participants wore intermittently scanned CGM for a median of 12.0 days. The relationships between different predefined time above ranges (TARs), with the thresholds of hyperglycaemia ranging from 7.8 to 13.9 mmol/l (140–250 mg/dl), and in-hospital mortality risk were assessed by multivariate Cox proportional regression analysis. Time in ranges (TIRs) of 3.9 mmol/l (70 mg/dl) to the predefined hyperglycaemic thresholds were also assessed.

Results

Overall, 66 (22.5%) in-hospital deaths were identified. Only TARs with a threshold of 10.5 mmol/l (190 mg/dl) or above were significantly associated with the risk of in-hospital mortality, after adjustment for covariates. Furthermore, as the thresholds for TAR increased from 10.5 mmol/l to 13.9 mmol/l (190 mg/dl to 250 mg/dl), the hazards of in-hospital mortality increased incrementally with every 10% increase in TARs. Similar results were observed concerning the associations between TIRs with various upper thresholds and in-hospital mortality risk. For per absolute 10% decrease in TIR 3.9–10.5 mmol/l (70–190 mg/dl), the risk of in-hospital mortality was increased by 12.1% (HR 1.121 [95% CI 1.003, 1.253]).

Conclusions/interpretation

A glucose level exceeding 10.5 mmol/l (190 mg/dl) was significantly associated with higher risk of in-hospital mortality in critically ill patients.

Graphical Abstract

Supplementary Information

The online version of this article (10.1007/s00125-024-06136-1) contains peer-reviewed but unedited supplementary material.

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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino, Thomas Danne, Richard M. Bergenstal … (2019)

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.

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APACHE II: a severity of disease classification system.

W A Knaus, E A Draper, D P Wagner … (1985)

This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. An increasing score (range 0 to 71) was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals. This relationship was also found for many common diseases. When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.

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Author and article information

Contributors

Yingchuan Li:

ORCID: http://orcid.org/0000-0002-5522-4402

yingchuan_li@tongji.edu.cn

Weifeng Huang:

ORCID: http://orcid.org/0000-0002-8084-8831

breeze-huang@hotmail.com

Jian Zhou:

ORCID: http://orcid.org/0000-0002-1534-2279

zhoujian@sjtu.edu.cn

Journal

Journal ID (nlm-ta): Diabetologia

Journal ID (iso-abbrev): Diabetologia

Title: Diabetologia

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0012-186X

ISSN (Electronic): 1432-0428

Publication date (Electronic): 3 April 2024

Publication date PMC-release: 3 April 2024

Publication date (Print): 2024

Volume: 67

Issue: 7

Pages: 1295-1303

Affiliations

[1 ]Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, ( https://ror.org/0220qvk04) Shanghai, China

[2 ]Department of Anesthesiology, Tongji University Affiliated Shanghai Tenth People’s Hospital, ( https://ror.org/03vjkf643) Shanghai, China

[3 ]Department of Critical Care Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, ( https://ror.org/0220qvk04) Shanghai, China

[4 ]Department of Critical Care Medicine, Jinshan Branch of Shanghai Sixth People’s Hospital, ( https://ror.org/049zrh188) Shanghai, China

[5 ]Department of Critical Care Medicine, Shanghai Fengxian District Central Hospital, Shanghai, China

[6 ]Department of Critical Care Medicine, Shanghai Eighth People’s Hospital, ( https://ror.org/0309pcg09) Shanghai, China

[7 ]Department of Critical Care Medicine, Shanghai Sixth People’s Hospital East Campus, ( https://ror.org/049zrh188) Shanghai, China

[8 ]Department of Critical Care Medicine, Tongji University Affiliated Shanghai Tenth People’s Hospital, ( https://ror.org/03vjkf643) Shanghai, China

[9 ]Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China

Author information

Yingchuan Li http://orcid.org/0000-0002-5522-4402

Weifeng Huang http://orcid.org/0000-0002-8084-8831

Jian Zhou http://orcid.org/0000-0002-1534-2279

Article

Publisher ID: 6136

DOI: 10.1007/s00125-024-06136-1

PMC ID: 11153265

PubMed ID: 38568252

SO-VID: 8d765da6-7a26-4c1b-9fd5-11c72c5b440d

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 29 October 2023

Date accepted : 22 February 2024

Funding

Funded by: Program of Shanghai Academic/Technology Research Leader

Award ID: 22XD1402300

Funded by: Shanghai “Rising Stars of Medical Talent” Youth Development Program–Outstanding Youth Medical Talents

Award ID: SHWSRS(2021)_099

Funded by: Shanghai Research Center for Endocrine and Metabolic Diseases

Award ID: 2022ZZ01002

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: continuous glucose monitoring,critically ill patients,threshold of hyperglycaemia

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: continuous glucose monitoring, critically ill patients, threshold of hyperglycaemia

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Threshold of hyperglycaemia associated with mortality in critically ill patients: a multicentre, prospective, observational study using continuous glucose monitoring

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 36

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

APACHE II: a severity of disease classification system.

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