Glycaemic variability in diabetes inpatients — ASN Events
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  3. Glycaemic variability in diabetes inpatients

Glycaemic variability in diabetes inpatients (#345)

Mervyn Kyi 1 , Stella Italiano 2 , Peter G Colman 1 , Spiros Fourlanos 1
  1. Royal Melbourne Hospital, Parkville, Vic, Australia
  2. Royal Melbourne Hospital clinical school, The University of Melbourne, Melbourne, Victoria, Australia

Background:

Hospital inpatients with diabetes have poorer clinical outcomes than those without diabetes. In critical care, glycaemic variability (GV) is a predictor of mortality, and in general ward patients GV has been associated with increased length of stay (LOS) and 90-day mortality. We aimed to assess GV in diabetes inpatients to determine its relationship to age, insulin therapy, type 1 diabetes (T1D), hypoglycaemia, chronic kidney disease (CKD), and length of stay (LOS).

Methods:

Diabetes inpatients in medical and surgical wards (n=210) with a minimum three days LOS had glucose control monitored in the first 72 hours after admission. GV was assessed by standard deviation (SD) of capillary blood glucose levels (BGL), and coefficient of variation (CV) calculated as the ratio of SD to mean glucose.

Results:

The cohort had a mean age of 69.7±14.7years, HbA1c: 7.5±1.8%, and 38% were receiving insulin prior to admission. The median LOS was 9.0 (6-14 interquartile range) days.  The mean BGL was 9.8 mmol/L and 58% of BGL readings were within target range (4.0-9.9 mmol/L). Hyperglycaemia (≥10.0mmol/L) and hypoglycaemia (<4.0mmol/L) occurred in 64%, and 6% of patient-days respectively. Overall measures of GV were SD: 2.9±1.4 mmol/L and CV: 29±11%. GV was not associated with age, CKD or LOS. However, GV was significantly greater in patients treated with insulin (CV: 32±11% vs. 24±8%, p<0.0001), T1D (CV: 40±9% vs. 28±10%, p<0.0001) and hypoglycaemic episodes (CV: 40±10% vs. 26±9%, p<0.0001). GV did not diminish over the 3 days. GV on day 1 correlated with GV on days 2-3 (r=0.285, p=0.0002).

Conclusion:

Glycaemic variability in diabetes inpatients is persistent and greater with insulin therapy, type 1 diabetes and hypoglycaemia. Earlier intervention in higher risk patients to reduce glycaemic variability may decrease adverse effects related to hypoglycaemia and hyperglycaemia.

  1. Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105(2):244-252.
  2. Mendez CE, Mok KT, Ata A, et al. Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care. 2013;36(12):4091-4097.