Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness.
OBJECTIVE
Stress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness.


METHODS
Retrospective cohort study.


METHODS
All adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011.


METHODS
Stress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression.


RESULTS
Stress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness.


CONCLUSIONS
Stress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.
Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia.
Mark P
MP
Plummer
Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia.
Mark E
ME
Finnis
Discipline of Medicine, University of Adelaide, Level 6 Eleanor Harrald Building, Adelaide, South Australia, Australia.|Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Liza K
LK
Phillips
Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia.
Palash
P
Kar
Department of Critical Care Medicine, Flinders University, Bedford Park, South Australia, Australia.|Department of Intensive Care Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Shailesh
S
Bihari
Department of Intensive Care Medicine, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
Vishwanath
V
Biradar
Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Stewart
S
Moodie
Discipline of Medicine, University of Adelaide, Level 6 Eleanor Harrald Building, Adelaide, South Australia, Australia.|Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Michael
M
Horowitz
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Jonathan E
JE
Shaw
Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia.
Adam M
AM
Deane
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000209:etiology* / Q000401:mortality; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013312:Stress, Physiological / Q000502:physiology; D055815:Young Adult
D001786:Blood Glucose