title: Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.
abstract: Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.
authors.affiliation: Division of Endocrinology and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. gumpierrez@utmem.edu
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
authors.forename: Scott D
authors.initials: SD
authors.lastname: Isaacs
authors.forename: Niloofar
authors.initials: N
authors.lastname: Bazargan
authors.forename: Xiangdong
authors.initials: X
authors.lastname: You
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Thaler
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Kitabchi
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005215:Fasting / Q000097:blood; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D014481:United States
chemical_list: D001786:Blood Glucose