Related Experiment Video

Updated: Mar 15, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Prior exposure to hyperglycaemia attenuates the relationship between glycaemic variability during critical illness

Mark P Plummer¹, Mark E Finnis², Matthew Horsfall³

¹Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. adam.deane@adelaide.edu.au.

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine

|September 9, 2016

Abstract

Objective:

Our primary objective was to determine the impact of prior exposure to hyperglycaemia on the association between glycaemic variability during critical illness and mortality. Our secondary objectives included evaluating the relationships between prior hyperglycaemia and hyperglycaemia or hypoglycaemia during critical illness and mortality.

Design And Participants:

A single-centre, retrospective, observational study in a tertiary intensive care unit. Patients admitted to the ICU between 1 September 2011 and 30 June 2015, with diabetes recorded using ICD-10-AM coding or a glycated haemoglobin (HbA1c) level of ≥ 6.5%, were stratified by prior hyperglycaemic level (HbA1c < 6.5%, 6.5%-8.5%, or > 8.5%).

Main Outcome Measures:

Glycaemic variability was assessed as the blood glucose coefficient of variation during the patient's stay in the ICU. Multivariate logistic regression and marginal predictive plots were used to assess the impact of prior hyperglycaemia on the association between glycaemic metrics and mortality.

Results:

We studied 1569 patients with diabetes (HbA1c < 6.5%, n = 495; HbA1c 6.5%-8.5%, n = 731; and HbA1c > 8.5%, n = 343). Glycaemic variability was strongly associated with hospital mortality (P = 0.001), but this asso ciation showed a significant interaction with prior hyperglycaemia (P = 0.011), such that for patients with HbA1c > 8.5%, increasing glycaemic variability was not associated with increased mortality. Acute hyperglycaemia was strongly associated with mortality (P < 0.0001) and also showed a significant interaction with prior hyperglycaemia (P = 0.001), such that for patients with HbA1c > 8.5%, acute hyperglycaemia was not associated with mortality. Hypoglycaemia was also associated with mortality (P < 0.0001), but prior exposure to hyperglycaemia had a lesser effect on this relationship.

Conclusion:

Prior exposure to hyperglycaemia attenuates the association between glycaemic variability and mortality in critically ill patients with diabetes.

More Related Videos

A Mouse Model of Hemorrhagic Transformation Induced by Acute Hyperglycemia Combined with Transient Focal Ischemia

A Mouse Model of Hemorrhagic Transformation Induced by Acute Hyperglycemia Combined with Transient Focal Ischemia

Published on: November 15, 2024

Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes

Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes

Published on: March 7, 2025

Related Concept Videos

Hypoglycemia and Glucagon

Hypoglycemia and Glucagon

Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...

Diabetes Mellitus: Type 2 and Gestational

Diabetes Mellitus: Type 2 and Gestational

Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...

Diabetes: Symptoms, Diagnosis, and Complications

Diabetes: Symptoms, Diagnosis, and Complications

For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...

Overview of Carbohydrate Metabolism

Overview of Carbohydrate Metabolism

Carbohydrate metabolism is a fundamental biochemical process that ensures a constant supply of energy to living cells. The most important carbohydrate is glucose, which can be broken down via glycolysis to enter into the Krebs cycle and eventually lead to the production of ATP through oxidative phosphorylation.
Glucose transport into cells is facilitated by a family of transport proteins called GLUT (Glucose Transporters). GLUT4 is the primary glucose transporter for insulin-stimulated glucose...

Pathophysiology of Diabetes

Pathophysiology of Diabetes

Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...

Oral Hypoglycemic Agents: Biguanides and Glitazones

Oral Hypoglycemic Agents: Biguanides and Glitazones

Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...

Articles linked to this work by shared authors, journal, and citation graph.

Proton pump inhibitors in invasively ventilated patients with SARS-CoV-2: a substudy of the re-evaluating the inhibition of stress erosions trial.

BMJ open·2026

The effect of augmented protein intake on nitrogen balance: A nested cohort study of the TARGET protein trial.

Journal of critical care·2026

Functional immune changes are conserved in COVID-19 and trauma patients receiving intensive care.

Nature communications·2026

Intravenous megadose sodium ascorbate normalises elevations in intracranial pressure and restores pressor responsiveness to norepinephrine in ovine Gram-negative sepsis.

Scientific reports·2026

Phenobarbital as an Adjuvant to benzodiazepines when compared to Single-agent benzodiazepine Treatment (usual care) for Alcohol withdrawal syndrome in the intensive care unit (PASTA): a study protocol.

Pilot and feasibility studies·2026

Conservative Oxygen for Unresponsive Patients after Cardiac Arrest.

The New England journal of medicine·2026

See all related articles