Characterizing Glucose Changes Antecedent to Hypoglycemic Events in the Intensive Care Unit.
Endocr Pract. 2011 Nov 8;:1-23
Authors: Cook CB, Potter DJ, Kongable GL
Objective: Little is known about the changes in glucose that occur leading up to hypoglycemia in the critically ill. We tested the hypothesis that patterns of glucose changes prior to hypoglycemia varied according to the severity of the event.Methods: Absolute glucose decrease (AGD), glucose rate of change (GROC), and glucose variability (GVAR) prior to hypoglycemic events (<40, 40-49, 50-59, and 60-69 mg/dL) were calculated. Comparisons were made to patients achieving a glucose range of 80 to 110 mg/dL without hypoglycemia.Results: A total of 128,419 point-of-care bedside glucose (POC-BG) measurements from 2,942 patients in 89 intensive care units were anlayzed. Patients who experienced the most severe hypoglycemic episodes had the largest absolute drop in their glucose levels prior to the event (P <.01). The GROC prior to a hypoglycemic event increased with worsening hypoglycemia: mean (SD) GROC was -1.69 (2.98) mg/dL/min prior an episode of <40 mg/dL, -0.56 (2.65) mg/dL/min prior to 60 to 69 mg/dL, but only -0.39 (0.70) for patients who attained a glucose range of 80 to 110 mg/dl without hypoglycemia (P <.01). GVAR prior to an event progressively increased with worsening biochemical hypoglycemia, and was least among persons achieving an 80 to 110 mg/dL range without hypoglycemia (P<.01).Conclusions: Antecedent glucose change and variability were greater for patients who experienced hypoglycemia. If monitored these patterns could potentially alert clinicians and help them take preventive measures. Further examination of how these parameters interact with other predisposing risk factors for hypoglycemia is warranted.
PMID: 22068252 [PubMed - as supplied by publisher]