title: Incidence and predisposing factors for the development of disturbed glucose metabolism and DIabetes mellitus AFter Intensive Care admission: the DIAFIC study.
abstract: BACKGROUND
  Elevated blood glucose levels during intensive care unit (ICU) stay, so-called stress hyperglycaemia (SH), is a common finding. Its relation with a future diabetes risk is unclear. Our objective was to determine the incidence of disturbed glucose metabolism (DGM) post ICU admission and to identify predictors for future diabetes risk with a focus on stress hyperglycaemia.
  
  
  METHODS
  This single center prospective cohort trial (DIAFIC trial) had a study period between September 2011 and March 2013, with follow-up until December 2013. The setting was a mixed medical/surgical ICU in a tertiary teaching hospital in Belgium. 338 patients without known diabetes mellitus were included for analysis. We assessed the level of glucose metabolism disturbance (as diagnosed with a 75 g oral glucose tolerance test (OGTT) and/or HbA1c level) eight months after ICU admission, and investigated possible predictors including stress hyperglycaemia.
  
  
  RESULTS
  In total 246 patients (73 %) experienced stress hyperglycaemia during the ICU stay. Eight months post-ICU admission, 119 (35 %) subjects had a disturbed glucose metabolism, including 24 (7 %) patients who were diagnosed with diabetes mellitus. A disturbed glucose metabolism tended to be more prevalent in subjects who experienced stress hyperglycaemia during ICU stay as compared to those without stress hyperglycaemia (38 % vs. 28 %, P = 0.065). HbA1c on admission correlated with the degree of stress hyperglycaemia. A diabetes risk score (FINDRISC) (11.0 versus 9.5, P = 0.001), the SAPS3 score (median of 42 in both groups, P = 0.003) and daily caloric intake during ICU stay (197 vs. 222, P = 0.011) were independently associated with a disturbed glucose metabolism.
  
  
  CONCLUSIONS
  Stress hyperglycaemia is frequent in non-diabetic patients and predicts a tendency towards disturbances in glucose metabolism and diabetes mellitus. Clinically relevant predictors of elevated risk included a high FINDRISC score and a high SAPS3 score. These predictors can provide an efficient, quick and inexpensive way to identify patients at risk for a disturbed glucose metabolism or diabetes, and could facilitate prevention and early treatment.
  
  
  BACKGROUND
  At ClinicalTrials.gov NCT02180555 . Registered 1 July, 2014.
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. sofie.vanackerbroeck@hotmail.com.
authors.forename: Sofie
authors.initials: S
authors.lastname: Van Ackerbroeck
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. tom.schepens@uza.be.
authors.forename: Tom
authors.initials: T
authors.lastname: Schepens
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. jans.karo@gmail.com.
authors.forename: Karolien
authors.initials: K
authors.lastname: Janssens
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. philippe.jorens@uza.be.|Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. philippe.jorens@uza.be.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium. walter.verbrugghe@uza.be.
authors.forename: Walter
authors.initials: W
authors.lastname: Verbrugghe
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, B-2650, Edegem, Belgium. sandra.collet@uza.be.
authors.forename: Sandra
authors.initials: S
authors.lastname: Collet
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. viviane.vanhoof@uza.be.|Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium. viviane.vanhoof@uza.be.
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Hoof
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. luc.vangaal@uza.be.|Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, B-2650, Edegem, Belgium. luc.vangaal@uza.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Van Gaal
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. christophe.deblock@uza.be.|Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, B-2650, Edegem, Belgium. christophe.deblock@uza.be.
authors.forename: Christophe
authors.initials: C
authors.lastname: De Block
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005947:Glucose / Q000378:metabolism; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013312:Stress, Physiological; D055815:Young Adult
chemical_list: D005947:Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human