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 233 | SGLT-2 Inhibitors Special Edition March 2015 | Issue 773 | Diabetes Clinical Mastery Series Issue 232 | GLP-1 Special Editions March 2015 |

2015 Most Popular Articles:

FDA Approves Sanofi's Diabetes Drug Toujeo
Posted February 27, 2015
One Modification of Diet Can Improve the Metabolic Syndrome
Posted February 27, 2015
Eylea Bests Avastin, Lucentis in Diabetic Macular Edema
Posted February 27, 2015
'Smart' Insulin Holds Promise for Type 1 Diabetes Patients
Posted February 27, 2015
What Most Docs Don't Do: Counsel Patients on Drug Adherence
Posted February 27, 2015
Reduced GLP-1 Precedes Type 2 Diabetes
Posted March 05, 2015
Resistance Exercise after Dinner Decreases CVD Risk for Type 2's
Posted February 27, 2015
Breastfeeding May Lower Risk of Type 1 Diabetes
Posted February 27, 2015
Quality Management in Diabetes Care
Posted February 27, 2015
Custom Mobile App for Nurses Diagnoses More Obesity, Smoking and Depression
Posted February 27, 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
Are you interested in learning how to improve patient care by doing a reimbursable comprehensive diabetic foot exam?



Search Articles On Diabetes In Control