title: Diabetes mellitus and impaired glucose tolerance are underdiagnosed in intensive care units.
abstract: OBJECTIVE
  To evaluate the presence of diabetes mellitus and impaired glucose tolerance in intensive care unit inpatients.
  
  
  METHODS
  The study included patients in post-surgical care for elective and emergency surgery and excluded those patients with known diabetes mellitus. To diagnose prior serum glucose level disorders, we considered the value of glycated hemoglobin (HbA1c) at the time of admission, classifying the patients as normal (<5.7%), glucose intolerant (5.7-6.4%) or diabetic (>6.4%). During the first 3 days of the patient's hospital stay, glycemic control and clinical complications were assessed. Mortality was monitored for 28 days. For the statistical analyses, chi-square, ANOVA, student's t, Kruskal-Wallis or Mann Whitney tests were used.
  
  
  RESULTS
  Thirty patients were included in the present study, 53% of whom were women; the patients had a mean age of 53.4±19.7 years and an APACHE II score of 13.6±6.6. The majority of patients were admitted for severe sepsis or septic shock followed by post-operative care for elective surgery, oncological surgery, multiple traumas and emergency surgery. When classifying these patients according to HbA1c, despite the absence of a prior history of diabetes mellitus, only 13.3% had a normal HbA1c level, 23.3% had levels compatible with the diagnosis of diabetes mellitus and 63.3% had levels compatible with impaired glucose tolerance. We found a significant association between the diagnosis of diabetes mellitus or impaired glucose tolerance and the use of vasoactive drugs (p=0.04).
  
  
  CONCLUSIONS
  A high prevalence of undiagnosed diabetes mellitus and impaired glucose tolerance was observed in inpatients at a general intensive care unit.
authors.affiliation: Intensive Therapy Unit, Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - UNIFESP -São Paulo (SP), Brazil. rtlad@terra.com.br
authors.forename: Renata Teixeira
authors.initials: RT
authors.lastname: Ladeira
authors.forename: Ana Cinthia Marques
authors.initials: AC
authors.lastname: Simioni
authors.forename: Antonio Tonete
authors.initials: AT
authors.lastname: Bafi
authors.forename: Ana Paula Metran
authors.initials: AP
authors.lastname: Nascente
authors.forename: Flavio Geraldo Resende
authors.initials: FG
authors.lastname: Freitas
authors.forename: Flávia Ribeiro
authors.initials: FR
authors.lastname: Machado
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