High blood glucose variability is associated with bacteremia and mortality in patients hospitalized with acute infection

QJM. 2019 Feb 1;112(2):101-106. doi: 10.1093/qjmed/hcy235.


Background: Limited data are available regarding the association between glucose levels variability (GV) and outcomes of patients hospitalized with acute infectious diseases.

Aim: To determine the association between GV and bacteremia, length of stay (LOS) and mortality.

Methods: A retrospective study of patients hospitalized in departments of medicine with respiratory tract, urinary tract and skin and soft tissue infections during 2011-17. GV was assessed by the coefficient of variation (CV) of glucose levels during hospitalization and was divided into tertiles (CV ≤ 16%, 17-29%, >29%). LOS, bacteremia rates and all-cause mortality (30 days, 90 days and after 5 years) were evaluated for the patients with and without DM according the three GV categories.

Results: The study consisted of 1485 patients, 838 (56%) were diabetic. There was no significant association between GV and LOS. Bacteremia rates were higher in the upper GV tertile compared with the lower one (6% vs. 2%, P = 0.007). Mid and upper tertiles compared with the lower one were significantly associated with increased 30-day mortality (13% vs. 5%, P = 0.005; and 40% vs. 5%, P = 0.002, respectively). A decreased 5 years survival was observed for both diabetic and non-diabetic patients in the mid and upper GV tertiles [adjusted HRs 0.8 (95% CI, 0.6-1.04) and 0.6 (95% CI, 0.5-0.9) in diabetic patients and 0.7 (95% CI, 0.5-0.9) and 0.5 (95% CI, 0.3-0.7) in the non-diabetic ones].

Conclusion: In diabetic and non-diabetic patients, hospitalized in non-ICU setting with acute infectious diseases, increased GV is associated with increased risk of bacteremia, short and long-term mortality.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bacteremia / epidemiology*
  • Blood Glucose
  • Diabetes Mellitus / epidemiology*
  • Female
  • Hospital Mortality*
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / complications
  • Israel / epidemiology
  • Kaplan-Meier Estimate
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors


  • Blood Glucose