~ High Blood Sugar Levels Correlate with Intensive Care Mortality

Research published in the December 2003 issue of Mayo Clinic Proceedings has found an association between an elevation of blood glucose and the chance of dying in an intensive care unit. The finding was valid for diabetic and nondiabetic patients.

Clinical professor of medicine at the Columbia University College of Physicians and Surgeons, James Stephen Krinsley MD, analyzed data for 1,826 individuals who had been patients in the intensive care unit at The Stamford Hospital in Stamford, Connecticut. Diabetes was present in 22.4 percent of the group.

Dr Krinsley found that even a small elevation in blood glucose was associated with a significant increase in the deaths of patients with a variety of diagnoses. Among patients whose mean glucose levels were between 80 and 99 milligrams per deciliter, mortality rates were 9.6 percent. For those whose mean glucose levels were between 100 and 119 milligrams per deciliter (considered normal) mortality rose to 12.2 percent.

Mortality rates increased to 42.5 percent among patients whose mean glucose values were in excess of 300 milligrams per deciliter.

Hyperglycemia, or elevated blood sugar, is a common finding among the critically ill. Although it has been standard practice to tolerate a mild elevation in blood glucose in these patients, this study's findings suggest that glucose should be better managed and that additional studies should be conducted.

In an accompanying editorial in Mayo Clinic Proceedings, the Douglas B Coursin MD and Michael J Murray PhD, MD ask whether or not the relationship between hyperglycemia and increased mortality among the severely ill is causal. Dr Krinsley commented, "Although hyperglycemia can be a marker of severity of illness, it may also worsen outcomes. We think that tight glucose control results in improved vascular function and lower risk of infection."

Additionally, diabetes experts attending the American College of Endocrinology Consensus Development Conference on Inpatient Diabetes and Metabolic Control presented new guidelines today which recommend that all hospitalized patients, especially those in the critical care unit, those undergoing surgery and those with cardiovascular disease receive intensive monitoring and treatment to control blood sugar. Conference attendees said that adding the new recommendations will revolutionize patient care, reduce complications and save lives.

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