Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis.
Hyperglycaemia occurs frequently in critically ill patients without diabetes. We conducted a systematic review and meta-analysis to evaluate whether this 'stress hyperglycaemia' identifies survivors of critical illness at increased risk of subsequently developing diabetes.



We searched the MEDLINE and Embase databases from their inception to February 2016. We included observational studies evaluating adults admitted to the intensive care unit (ICU) who developed stress hyperglycaemia if the researchers reported incident diabetes or prediabetes diagnosed ≥3 months after hospital discharge. Two reviewers independently screened the titles and abstracts of identified studies and evaluated the full text of relevant studies. Data were extracted using pre-defined data fields, and risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled ORs with 95 % CIs for the occurrence of diabetes were calculated using a random-effects model.



Four cohort studies provided 2923 participants, including 698 with stress hyperglycaemia and 131 cases of newly diagnosed diabetes. Stress hyperglycaemia was associated with increased risk of incident diabetes (OR 3.48; 95 % CI 2.02-5.98; I2= 36.5 %). Studies differed with regard to definitions of stress hyperglycaemia, follow-up and cohorts studied.



Stress hyperglycaemia during ICU admission is associated with increased risk of incident diabetes. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.
Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. yasmine.aliabdelhamid@adelaide.edu.au.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia. yasmine.aliabdelhamid@adelaide.edu.au.
Yasmine
0000-0002-3340-1965
Y
Ali Abdelhamid
Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia.
Palash
P
Kar
Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia.
Mark E
ME
Finnis
Discipline of Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia.|Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.
Liza K
LK
Phillips
Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Mark P
MP
Plummer
Clinical Diabetes Laboratory, Baker IDI, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
Jonathan E
JE
Shaw
Discipline of Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia.|Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.
Michael
M
Horowitz
Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia.
Adam M
AM
Deane
D016638:Critical Illness / Q000401:mortality; D003920:Diabetes Mellitus / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000503:physiopathology; D011236:Prediabetic State / Q000503:physiopathology*; D013312:Stress, Physiological / Q000502:physiology*
Blood glucose; Critical care; Hyperglycaemia; Meta-analysis; Prediabetes; Type 2 diabetes mellitus
JAMA. 2000 Apr 19;283(15):2008-12
10789670
J Clin Endocrinol Metab. 2001 Mar;86(3):989-93
11238474
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
Lancet. 2002 Jun 22;359(9324):2140-4
12090978
BMJ. 2003 Sep 6;327(7414):557-60
12958120
Age Ageing. 2004 Jan;33(1):71-7
14695867
Diabet Med. 2004 Feb;21(2):103-13
14984444
Intensive Care Med. 2004 May;30(5):748-56
14991101
Diabetes Care. 1992 Jul;15(7):815-9
1516497
Crit Care Med. 2005 Sep;33(9):1994-2002
16148471
Diabetes Care. 2007 May;30(5):1102-6
17322480
Curr Diabetes Rev. 2006 Feb;2(1):113-30
18220621
JPEN J Parenter Enteral Nutr. 2008 May-Jun;32(3):227-35
18443133
Crit Care Med. 2008 Aug;36(8):2249-55
18664780
J Clin Endocrinol Metab. 2008 Nov;93(11):4238-44
18697862
J Clin Endocrinol Metab. 2008 Dec;93(12):4774-9
18826999
Diabetes Care. 2009 Feb;32(2):335-41
18957530
Acta Diabetol. 2010 Dec;47 Suppl 1:29-33
19340390
Lancet. 2009 May 23;373(9677):1773-9
19465232
Lancet. 2009 May 23;373(9677):1798-807
19465235
Crit Care. 2010;14(1):R6
20089197
Crit Care. 2010;14(4):R130
20615210
Crit Care Med. 2011 Feb;39(2):371-9
20959786
Crit Care. 2010;14(6):327
21067560
Crit Care. 2010;14(6):R224
21143980
N Engl J Med. 2011 Apr 7;364(14):1293-304
21470008
BMJ. 2011 Jul 22;343:d4002
21784880
Diabetes Care. 2011 Oct;34(10):2244-9
21816977
Crit Care. 2011;15(5):R205
21914173
Lancet. 2012 Jun 16;379(9833):2279-90
22683128
Am J Med. 2012 Oct;125(10):1036.e17-23
22863217
Diabetes Obes Metab. 2013 Sep;15(9):792-801
23368662
Diabetes Care. 2014 Feb;37(2):409-18
24089537
J Clin Epidemiol. 2014 Jun;67(6):622-8
24508144
Cochrane Database Syst Rev. 2014 Mar 18;(3):CD009578
24638998
Intensive Care Med. 2014 Jul;40(7):973-80
24760120
PLoS Med. 2014 Aug 19;11(8):e1001708
25136809
J Crit Care. 2015 Feb;30(1):150-5
25239822
Clin Nutr. 2015 Aug;34(4):557-64
25491245
J Clin Endocrinol Metab. 2015 Apr;100(4):1646-53
25706240
Stat Methods Med Res. 2017 Jun;26(3):1500-1518
25953957
Crit Care. 2015 Oct 02;19:355
26428846
Diabetes Care. 2016 Jan;39 Suppl 1:S36-8
26696678
Diabetes Care. 2016 Jan;39 Suppl 1:S99-104
26696689
Diabetes Care. 2016 Sep;39(9):1653
27555625
Am J Surg. 1978 Apr;135(4):577-83
345832
Diabetes Care. 1997 Apr;20(4):537-44
9096977