- March 20, 2014
Since the mid 1980s, scholarly articles have noted the link between hyperglycemia and increased mortality, even in patients without diabetes.1 But it wasn’t until 2001 that many accepted glucose control as an important component of a patient’s health, especially in intensive care environments.
And while the Centers for Medicare and Medicaid Services considers manifestations of poor glycemic control to be a Hospital-Acquired Condition for which it will not pay2, information sharing about the full extent to which hyperglycemia can affect a patient has lagged woefully behind. Some of the statistics all healthcare professionals should be familiar with include:
- 46% of patients in the ICU have hyperglycemia (blood glucose >180 mg/dL)3
- 12% of hospital patients develop new hyperglycemia (glucose readings of >126 mg/dL), even though they have not been previously diagnosed with diabetes4
- Hyperglycemia-related risk appears to vary depending on admission diagnosis, potentially complicating ideal control calculations5
- Hospital-wide, mortality is significantly higher in patients with new hyperglycemia (16%) than in patients with diabetes (3%) or normoglycemic (1.7%)4
But the issues don’t stop there:
- Patients with medium, high, worsening and highly variable hyperglycemia have been shown to experience:6
- Significantly increased ICU stays
- More days on a ventilator
- Higher infection rates
- Increased mortality rates
- Trauma patients with hyperglycemia (>140 mg/dL) experience:6
- More days on a ventilator
- More days in the ICU
- Longer hospital stays
- Significantly increased mortality rates
- Patients with persistent hyperglycemia during a hospital stay are more likely to be readmitted within six months than those with mean blood glucose of <140 mg/dL (51% vs. 37%; p=0.03)7
Since CMS may not pay for manifestations of poor glycemic control, this can place a significant burden on a hospital. Studies have shown that:
- Independent of diabetes status, patients with persistent hyperglycemia have longer stays (8.1 days vs. 5.2 days; P=0.001) and higher total hospital costs (median $8,940 vs. $6,892; p=0.01)7
- Prolonged hospital stay of >7 days (38% vs. 21%; p = 0.01) and total cost >$10,000/patient (46% vs. 29%; p = 0.01) are seen more commonly in patients with poor glucometrics7
- Length of stay increases by 2.5 days for each day a patient suffers from hypoglycemia (P < 0.0001)9
With the health and safety of patients, as well as the financial well-being of hospitals on the line, it is more imperative than ever to maintain glycemic control of patients at all times.
1. Krinsley JS. Glycemic variability and mortality in critically ill patients: the impact of diabetes. J Diabetes Sci Technol.2009;3(6):1292-1301.
2. Manifestations of Poor Glycemic Control; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 411, 412, 413, 422, and 489 (19 August 2008) pp. 48433-49084. Accessed April 27, 2010.
3. Cook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control: a glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):E7–E14.
4. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978-982.
5. Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37(12):3001-3009.
6. Bochicchio, et al, 2005, Table 2.
7. Adigopula, S. , Feng, Y. , Babu, V. , Parperis, K. , Amoateng-Adjepong, Y. and Zarich, S. (2013) Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure. World Journal of Cardiovascular Diseases, 3, 245-249.
8. Desouza CV, Bolli GB, Fonseca V. (2010) Hypoglycemia, diabetes, and cardiovascular events. Diabetes Care 33:1389–1394.
9. Turchin A, Matheny ME, Shubina M, Scanlon JV, Greenwood B, Pendergrass ML. (2009) Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 32:1153–1157.