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Glycated hemoglobin A1C and diabetes mellitus in critically ill patients

Hai-Yan Zhang1, Cai-Jun Wu2, Chun-Sheng Li2

  • 1Department of Emergency Medicine, Shunyi Hospital, China Medical University, Beijing 101300, China.

World Journal of Emergency Medicine
|September 13, 2014
PubMed

Insights

Hyperglycemia is common in critically ill patients. Elevated glycated hemoglobin A1C (HbA1c) indicates poorer prognosis, especially in non-diabetics, highlighting the need for management.

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Emergency Medicine

Background:

  • Hyperglycemia is frequently observed in critically ill patients within emergency medicine settings.
  • The underlying mechanisms and prognostic implications of hyperglycemia in this population remain incompletely understood.
  • Glycated hemoglobin A1C (HbA1c) measurement was employed to assess hyperglycemia's impact on patient outcomes.

Purpose of the Study:

  • To investigate the prevalence and prognostic significance of hyperglycemia in critically ill patients.
  • To evaluate the role of glycated hemoglobin A1C (HbA1c) in predicting short-term outcomes.
  • To differentiate hyperglycemia causes between diabetic and non-diabetic critically ill patients.

Main Methods:

  • A cohort of 826 critically ill patients from an emergency medicine department was analyzed.
  • Patients were categorized into diabetes mellitus and non-diabetes mellitus groups.
  • Fasting glucose and HbA1c levels were measured; diabetic patients were further subgrouped by drug therapy for outcome analysis.

Main Results:

  • Elevated fasting glucose was observed in 78.8% of patients; HbA1c was elevated in 45.5%.
  • Diabetic patients showed higher rates of hyperglycemia (88.6%) and elevated HbA1c (78.3%) compared to non-diabetics (75.9% and 36.1%, respectively).
  • Drug therapy in diabetic patients significantly improved fasting glucose, HbA1c, and 28-day mortality; higher glucose levels correlated with increased mortality.

Conclusions:

  • Hyperglycemia in critically ill patients is not solely due to stress response, particularly in those without prior diabetes.
  • Prognosis associated with hyperglycemia varies significantly among critically ill patients.
  • Glycated hemoglobin A1C (HbA1c) serves as a valuable indicator for assessing hyperglycemia and predicting outcomes in critical care.
Abstract

Keywords:
Critically ill patientsDiabetes mellitusGlycosylated hemoglobin A1CHyperglycemiaPrognosis

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