Sign up for our complimentary
weekly e-journal

Main Newsletter
Mastery Series
Therapy Series
 
Bookmark and Share | Print Article | Items for the Week Previous | All Articles This Week | Next
This article originally posted and appeared in  Issue 507CardiovascularCulturally Aware Care

Diabetes Linked to Improved Survival in Critically Ill Patients

Consistent with prior reports, but still surprising, diabetes does not worsen hospital mortality in critically ill patients, researchers say. In fact, diabetes is often associated with improved survival....

Advertisement

The analysis covered more than 1.5 million subjects in a retrospective cohort and more than 36,000 subjects in a prospective cohort.

Senior author Dr. Ivor S. Douglas wrote, "Our observations robustly correlate with those of other investigators in the field.... Mortality was lower in diabetes for all ... diagnoses except acute myocardial infarction -- consistent with smaller studies."

In the January 10th issue of Critical Care Medicine, Dr. Douglas of the University of Colorado, Denver, and colleagues report that in the larger retrospective cohort, patients with a history of diabetes had a lower risk of in-hospital mortality compared to nondiabetics. Before adjustment, the odds ratio was 0.90; after adjustment, it was 0.75.

In the prospective cohort, after adjustment for age and severity of illness, the odds ratio for mortality was 0.88 in the diabetes group.

In the retrospective dataset, diabetic patients in all severity-of-illness categories had lower hospital mortality compared to nondiabetics. In the prospective dataset, diabetic patients with extreme severity of illness had decreased age-adjusted hospital mortality.

"The surprising finding highlights that despite decades of investigation we continue to have a limited understanding of the pathophysiological modifying effects of diabetes in critical illness," Dr. Douglas said. "Our data suggest that there is a potential protective effect in diabetics of hyperglycemia but relative intolerance of hypoglycemia."

He continued, "Importantly, there was a particularly detrimental effect of acute hyperglycemia in nondiabetic patients which may account for the significant difference in mortality we found between diabetic and nondiabetic patients in critical illness."

Dr. Douglas and his coauthors acknowledge that their findings "may seem counterintuitive." But they also point out that "preexisting diabetes is not a chronic health parameter in the calculation of APACHE III or IV," because it did not independently predict mortality when those scores were derived.

Now, the researchers conclude, it's time "to evaluate potential mechanisms for this association that might be therapeutically exploitable."

Crit Care Med 2010;38:16-24.
Advertisement


 

Bookmark and Share | Print | Category | Home

This article originally posted 02 February, 2010 and appeared in  Issue 507CardiovascularCulturally Aware Care

Past five issues: Diabetes Clinical Mastery Series Issue 251 | Issue 791 | Diabetes Clinical Mastery Series Issue 250 | GLP-1 Special Editions July 2015 | Issue 790 |

2015 Most Popular Articles:

Self-Monitoring of Blood Glucose: The Patient's Perspective
Posted July 10, 2015
The Impact of Glucagon-Like Peptide 1 Receptor Agonists on Weight Reduction
Posted July 10, 2015
Diet That Mimics Fasting Appears to Slow Aging
Posted July 03, 2015
Vitamin D3 Supplementation and Weight Loss Prevent Cancer in Older Women
Posted July 10, 2015
Evaluation of Cellphone Application that Records Readings from Glucometer
Posted July 10, 2015
Important Advances in Type 1 Diabetes Research
Posted June 25, 2015
Can the Insulin Patch Become a Reality?
Posted July 03, 2015
New Evidence Suggests Pioglitazone Reduces Dementia Risk 42%
Posted July 03, 2015
Metformin May Increase Mortality in Advanced CKD among Type 2 Patients
Posted July 10, 2015
GLP-1 Receptor Agonists Reduce Bone Loss During Weight Loss
Posted July 17, 2015


Browse by Feature Writer & Article Category.
A. Lee Dellon, MD | Aaron I. Vinik, MD, PhD, FCP, MACP | Beverly Price | Charles W Martin, DD | Derek Lowe, PhD | Dr. Brian Jakes, Jr. | Dr. Fred Pescatore | Dr. Tom Burke, Ph.D | Eric S. Freedland | Evan D. Rosen | Ginger Kanzer-Lewis | Greg Milliger | Kristina Sandstedt | Laura Plunkett | Leonard Lipson, M.A. | Louis H. Philipson | Maria Emanuel Ryan, DDS, PhD | Marilyn Porter, RD, CDE | Melissa Diane Smith | Michael R. Cohen, RPh, MS, ScD, FASHP | Paul Chous, M.A., OD | Philip A. Wood PhD | R. Keith Campbell, Professor, B.Pharm, MBA, CDE | Richard K. Bernstein, MD | Sheri R. Colberg PhD | Sherri Shafer | Stanley Schwartz, MD, FACP, FACE | Steve Pohlit | Steven V. Edelman, M.D. | Timothy S. Hollingshead |

Cast Your Vote
Would you be interested in a urine test strip product that measures microalbumin and creatinine levels to determine kidney failure risk in your patients?