WHAT IS STRESS HYPERGLYCEMIA? A SUGGESTION FOR AN IMPROVEMENT OF ITS DEFINITION.

Area of Science:

• Endocrinology
• Cardiology
• Critical Care Medicine

Background:

• Stress hyperglycemia is a common complication in critical illnesses, including acute myocardial infarction (AMI).
• The current definition of stress hyperglycemia, established in 2007, has not been updated despite extensive research.
• The existing definition fails to adequately address the nuances of hyperglycemia in AMI patients, particularly those with diabetes mellitus (DM).

Purpose of the Study:

• To conduct a narrative review on stress hyperglycemia in AMI.
• To propose an updated definition for stress hyperglycemia in the context of AMI.
• To provide evidence supporting the proposed definition and highlight the need for expert consensus.

Main Methods:

• A narrative review of existing literature on stress hyperglycemia in AMI.
• Analysis of current definitions and their limitations.
• Development of a revised definition incorporating patient subgroups.

Main Results:

• The 2007 definition of stress hyperglycemia is insufficient for AMI patients.
• A new definition is proposed: 'SH is a high arterial blood glucose (ABGly) in an AMI patient irrespective of DM status.'
• This definition can be operationalized using metrics like the 'stress hyperglycemia ratio' or 'admission glucose delta'/'glycemic gap', and considers glycated hemoglobin for patients with DM.

Conclusions:

• The current definition of stress hyperglycemia requires revision.
• An updated, evidence-based definition for stress hyperglycemia in AMI is recommended.
• A universal definition for stress hyperglycemia is crucial for optimizing treatment in critical illnesses.