Critical Illness-Associated Hyperglycemia and New-Onset Diabetes: A Retrospective Cohort Study

Abstract

Objective: To evaluate the relationship between critical illness-associated hyperglycemia (CIAH) during ICU treatment and the development of incident diabetes in ICU survivors without pre-existing diabetes or prediabetes.

Design: Retrospective observational study.

Setting: Four university hospital ICUs in Stockholm, Sweden.

Patients: A total of 6633 ICU survivors admitted between 2010 and 2021, with no prior diabetes diagnosis recorded in the Swedish National Diabetes Register (NDR) and a glycated hemoglobin A1c level below 42 mmol/mol (6%) at admission.

Interventions: None.

Measurements and main results: CIAH was defined as insulin administration to maintain blood glucose between 6 and 10 mmol/L (108-180 mg/dL) in ICU. Incident diabetes was defined as an NDR registration after ICU discharge, occurring beyond 30 days until September 2023. Overall, 3100 (46.7%) patients developed CIAH in the ICU. The 5-year cumulative diabetes incidence was higher in patients with CIAH (4.1%, 95% CI, 3.4-4.9%) compared with those without CIAH (1.8%, 95% CI, 1.3-2.3%). On multivariable Cox regression, the adjusted hazard ratio for incident diabetes was 2.15 (95% CI, 1.52-3.03) in patients with CIAH. Similarly, multivariable competing risk analysis revealed an adjusted sub-hazard ratio of 2.20 (95% CI, 1.57-3.08) for CIAH.

Conclusions: CIAH in ICU patients without pre-existing diabetes or prediabetes was associated with a higher risk of developing incident diabetes within 5 years of ICU discharge.

Keywords: critical care; critical care outcomes; diabetes mellitus; hyperglycemia; insulin; intensive care units; physiological; stress.