Volume 32, Issue 7 (October 2021)
Studies in Medical Sciences 2021, 32(7): 548-557 |
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Hatamkhani S, Tajeri A, Shiva A, Valizadeh Hassanlouei M A, Sharifi H. DETERMINATION OF THE PREVALENCE AND CLINICAL OUTCOME OF STRESS-INDUCED HYPERGLYCEMIA IN ICU OF IMAM KHOMEINI HOSPITAL, URMIA. Studies in Medical Sciences 2021; 32 (7) :548-557
URL: http://umj.umsu.ac.ir/article-1-4810-en.html
URL: http://umj.umsu.ac.ir/article-1-4810-en.html
Shima Hatamkhani 
, Akbar Tajeri , Afshin Shiva * 
, Mohammad Amin Valizadeh Hassanlouei , Hamdollah Sharifi
, Akbar Tajeri , Afshin Shiva * , Mohammad Amin Valizadeh Hassanlouei , Hamdollah Sharifi
Patient Safety Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran (Corresponding Author) , shiva@umsu.ac.ir
Abstract: (1948 Views)
Background & Aims: Over the past decade, inpatient hyperglycemia has become a major focus, due to its association with increased mortality, hospitalization complications, and its negative economic impact. Patients with hyperglycemia have greater mortality, postoperative stroke, and longer length of stay. Therefore, the aim of this study was to determine the prevalence of hyperglycemia and its therapeutic approach in the Intensive Care Unit (ICU).
Materials & Methods: This descriptive study was perfumed in the ICU of Imam Khomeini Educational Hospital in Urmia in 2016-2017. According to sample size determination, about 120 patients who were admitted to ICU for more than 24 hours were enrolled. The AACE / ADA 2009 guideline was used as a standard for hyperglycemic stress control.
Results: The records of 120 non-diabetic patients were studied for stress-induced hyperglycemia. The rate of stress-induced hyperglycemia was 19.2%. The mean age of the patients was 39 ± 24 years. The most common cause of hospitalization in ICU was traumatic problems (37.5%). About 57% of patients with hyperglycemia received intravenous feeding, 60.9% received corticosteroids, and 39.1% received vasopressor. Twenty-one (86.9%) patients used the SSI method and 3 (13.1%) used the infusion technique. The mortality rate was 35% for the patients admitted and 60.9% for patients with hyperglycemia.
Conclusion: In this study, the prevalence of hyperglycemia in the ICU was similar and relatively high in almost the same studies. Therefore, it seems that 6-hour blood glucose control has a better effect than once a day. In this study, most patients received SSI insulin for controlling hyperglycemia, while according to AACE / ADA 2009 guideline, the insulin infusion method is more appropriate. Therefore, in order to reduce hypoglycemia and mortality, it is recommended to use the insulin infusion technique to control hyperglycemia.
Materials & Methods: This descriptive study was perfumed in the ICU of Imam Khomeini Educational Hospital in Urmia in 2016-2017. According to sample size determination, about 120 patients who were admitted to ICU for more than 24 hours were enrolled. The AACE / ADA 2009 guideline was used as a standard for hyperglycemic stress control.
Results: The records of 120 non-diabetic patients were studied for stress-induced hyperglycemia. The rate of stress-induced hyperglycemia was 19.2%. The mean age of the patients was 39 ± 24 years. The most common cause of hospitalization in ICU was traumatic problems (37.5%). About 57% of patients with hyperglycemia received intravenous feeding, 60.9% received corticosteroids, and 39.1% received vasopressor. Twenty-one (86.9%) patients used the SSI method and 3 (13.1%) used the infusion technique. The mortality rate was 35% for the patients admitted and 60.9% for patients with hyperglycemia.
Conclusion: In this study, the prevalence of hyperglycemia in the ICU was similar and relatively high in almost the same studies. Therefore, it seems that 6-hour blood glucose control has a better effect than once a day. In this study, most patients received SSI insulin for controlling hyperglycemia, while according to AACE / ADA 2009 guideline, the insulin infusion method is more appropriate. Therefore, in order to reduce hypoglycemia and mortality, it is recommended to use the insulin infusion technique to control hyperglycemia.
Keywords: Stress-induced Hyperglycemia, ICU, Mortality, Sliding Scale Insulin, Insulin Infusion, AACE / ADA 2009 guidelines
Type of Study: Research |
Subject:
فارماکولوژی
References
1. Egi M, Krinsley JS, Maurer P, Amin DN, Kanazawa T, Ghandi S, et al. Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality. Intensive Care Med 2016;42(4):562-71. [DOI:10.1007/s00134-016-4216-8] [PMID]
2. Padilla N. Intensive Glucose Management in Critically Ill Patients Improves Patient Outcomes. Pharm Pract 2007:1-9. [URL]
3. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354(5):449-61. [DOI:10.1056/NEJMoa052521] [PMID]
4. Butler SO, Btaiche IF, Alaniz C. Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy 2005;25(7):963-76. [DOI:10.1592/phco.2005.25.7.963] [PMID]
5. Viana MV, Moraes RB, Fabbrin AR, Santos MF, Gerchman F. Assessment and treatment of hyperglycemia in critically ill patients. Rev Bras Ter Intensiva 2014;26(1):71-6. [DOI:10.5935/0103-507X.20140011] [PMID] [PMCID]
6. Campbell RK. Etiology and effect on outcomes of hyperglycemia in hospitalized patients. Am J Health Syst Pharm 2007;64(10 Suppl 6):S4-8. [DOI:10.2146/ajhp070100] [PMID]
7. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin 2001;17(1):107-24. [DOI:10.1016/S0749-0704(05)70154-8]
8. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67(2):352-60. [DOI:10.1016/S0003-4975(99)00014-4]
9. DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Rhee C, Wells A, et al. Inpatient management of hyperglycemia: the Northwestern experience. Endocr Pract 2006;12(5):491-505. [DOI:10.4158/EP.12.5.491] [PMID]
10. Rachabattula H, Simmons E, Ghatahora S, Grant P. The variable rate intravenous insulin infusion in clinical practice 2015: An audit against the new JBDS guidance. British Journal of Diabetes 2016;16(1):25-9. [DOI:10.15277/bjd.2016.059]
11. Kreider KE, Lien LF. Transitioning safely from intravenous to subcutaneous insulin. Curr Diab Rep 2015;15(5):23. [DOI:10.1007/s11892-015-0595-4] [PMID]
12. Peng L. Inpatient Glycemic Control With Sliding Scale Insulin in Noncritical Patients With Type 2 Diabetes: Who Can Slide? J Hosp Med 2021;16(8):462-8. [DOI:10.12788/jhm.3654] [PMID] [PMCID]
13. Hassan KA. Management of Hyperglycemia in ICU setting. Bangladesh Critical Care Journal 2021;9(2):65-7. [DOI:10.3329/bccj.v9i2.56151]
14. Cogle SV, Smith SE, Maish GO, Minard G, Croce MA, Dickerson RN. Sliding scale regular human insulin for identifying critically ill patients who require intensive insulin therapy and for glycemic control in those with mild to moderate hyperglycemia. J Pharm Nutr Sci 2017;7(3):106-15. [DOI:10.6000/1927-5951.2017.07.03.6]
15. Becker T, Moldoveanu A, Cukierman T, Gerstein HC. Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia. Diabetes Res Clin Pract 2007;78(3):392-7. [DOI:10.1016/j.diabres.2007.05.003] [PMID]
16. Lee Y-Y, Lin Y-M, Leu W-J, Wu M-Y, Tseng J-H, Hsu M-T, et al. Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials. Metabolism 2015;64(9):1183-92. [DOI:10.1016/j.metabol.2015.05.011] [PMID]
17. Moghissi E. AACE/ADA Inpatient Glycemic Control Consensus Panel. Endocr Pract 2009;15(4): 10-4158. [DOI:10.4158/EP09102.RA] [PMID]
18. Ala S, Salehifar E, Avan R, Ghasemishani S. Prevalence and Management of Stress Hyperglycemia in Critical Care Unit. J Mazandaran Univ Med Sci 2017;26(144):1-11. [Google Scholar]
19. Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patients. Jama 2003;290(15):2041-7. [DOI:10.1001/jama.290.15.2041] [PMID]
20. 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. [DOI:10.1097/CCM.0b013e3181b083f7] [PMID] [PMCID]
21. Moosavi Z, Hezarkhani S, Ebrahimzadeh S. Prevalence of Stress Hyperglycemia and Its Related Death Rate in Patients of Emam Reza Hospital Emergency Department of Mashad, Iran. J Diabetes Metab Disord 2009;8:3. [Google Scholar]
22. Godinjak A, Iglica A, Burekovic A, Jusufovic S, Ajanovic A, Tancica I, et al. Hyperglycemia in critically ill patients: management and prognosis. Med Arch 2015;69(3):157. [DOI:10.5455/medarh.2015.69.157-160] [PMID] [PMCID]
23. Gabbanelli V, Pantanetti S, Donati A, Principi T, Pelaia P. Correlation between hyperglycemia and mortality in a medical and surgical intensive care unit. Minerva Anestesiol 2005;71(11):717-25. [Google Scholar]
24. Pasquel FJ, Spiegelman R, McCauley M, Smiley D, Umpierrez D, Johnson R, et al. Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care 2010;33(4):739-41. [DOI:10.2337/dc09-1748] [PMID] [PMCID]
25. Yan C-L, Huang Y-B, Chen C-Y, Huang G-S, Yeh M-K, Liaw W-J. Hyperglycemia is associated with poor outcomes in surgical critically ill patients receiving parenteral nutrition. Acta Anaesthesiol Taiwan 2013;51(2):67-72. [DOI:10.1016/j.aat.2013.06.004] [PMID]
26. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009;32(6):1119-31. [DOI:10.2337/dc09-9029] [PMID] [PMCID]
27. Jain V, Patel RK, Kapadia Z, Galiveeti S, Banerji M, Hope L. Drugs and hyperglycemia: A practical guide. Maturitas 2017;104:80-3. [DOI:10.1016/j.maturitas.2017.08.006] [PMID]
28. Elena C, Chiara M, Angelica B, Chiara MA, Laura N, Chiara C, et al. Hyperglycemia and diabetes induced by glucocorticoids in nondiabetic and diabetic patients: revision of literature and personal considerations. Curr Pharm Biotechnol 2018;19(15):1210-20. [DOI:10.2174/1389201020666190102145305] [PMID]
29. Kowalchuk C, Castellani LN, Chintoh A, Remington G, Giacca A, Hahn MK. Antipsychotics and glucose metabolism: how brain and body collide. Am J Physiol Endocrinol Metab 2019;316(1):E1-E15. [DOI:10.1152/ajpendo.00164.2018] [PMID]
30. Chen J, Huang X-F, Shao R, Chen C, Deng C. Molecular mechanisms of antipsychotic drug-induced diabetes. Front Neurosci 2017;11:643. [DOI:10.3389/fnins.2017.00643] [PMID] [PMCID]
31. Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care 2005;28(10):2367-71. [DOI:10.2337/diacare.28.10.2367] [PMID]
32. Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care 2004;27(2):461-7. [DOI:10.2337/diacare.27.2.461] [PMID]
33. Zimmerman CR, Mlynarek ME, Jordan JA, Rajda CA, Horst HM. An insulin infusion protocol in critically ill cardiothoracic surgery patients. Ann Pharmacother 2004;38(7-8):1123-9. [DOI:10.1345/aph.1E018] [PMID]
34. Schmeltz LR. Management of inpatient hyperglycemia. Lab Med 2011;42(7):427-34. [DOI:10.1309/LMU72V7QWUDUYQIJ]
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