Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio
Aim Stress‐induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Q...
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| Veröffentlicht in: | Diabetic medicine 2022-10, Vol.39 (10), p.e14930-n/a |
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| creator | Roberts, Gregory W. Larwood, Crystal Krinsley, James S. |
| description | Aim
Stress‐induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A1c (HbA1c).
Methods
We identified eligible patients for eight medical (n = 892) and eight surgical (n = 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR.
Results
Analysis of variance indicated differing SHR and BG within both the medical (p |
| doi_str_mv | 10.1111/dme.14930 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2700642752</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2713088518</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3530-3b808d71b6ba475343efc6caf52307e4c68f79d2fa19e7f7eee22358cfb8e6513</originalsourceid><addsrcrecordid>eNp1kbFu2zAQhokiQeO4GfoCBYEsySCHFElRGoPEbQO4KAo0s0BRR5uOJDqkhEBb-wZ5xj5J6NjJYKC33HAfvrvDj9BnSmY01lXdwozygpEPaEJ5xhPBC3qEJkTyNGFE0hN0GsKaEJoWrPiITpgouMiKbIL-_hpU11tjteqt67AzOPQeQvj359l29aChxqtxA37ZjFpBaxVWIThtVR8nT7Zf4QcYcW3VsnOhtxpHESydtxDwEGy3xP0K9s5Dk9_u_ISOjWoCnO37FN1_nf---Z4sfn67u7leJJoJRhJW5SSvJa2ySnEpGGdgdKaVEWn8ELjOciOLOjWKFiCNBIA0ZSLXpsohE5RN0cXOu_HucYDQl60NGppGdeCGUKaSkIynMvqm6PwAXbvBd_G6SFFG8lzQPFKXO0p7F4IHU268bZUfS0rKbS5lzKV8zSWyX_bGoWqhfiffgojA1Q54sg2M_zeVtz_mO-ULcdibCA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2713088518</pqid></control><display><type>article</type><title>Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Roberts, Gregory W. ; Larwood, Crystal ; Krinsley, James S.</creator><creatorcontrib>Roberts, Gregory W. ; Larwood, Crystal ; Krinsley, James S.</creatorcontrib><description>Aim
Stress‐induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A1c (HbA1c).
Methods
We identified eligible patients for eight medical (n = 892) and eight surgical (n = 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR.
Results
Analysis of variance indicated differing SHR and BG within both the medical (p < 0.0001 for both) and surgical cohort (p < 0.0001 for both). Diagnostic categories were associated with signature levels of SHR that varied between groups. Medically, SHR was greatest for ST‐elevation myocardial infarction (1.22 ± 0.33) and sepsis (1.37 ± 0.43). Surgically, SHR was greatest for colectomy (1.62 ± 0.48) and cardiac surgeries (coronary artery graft 1.56 ± 0.43, aortic valve replacement 1.71 ± 0.33, and mitral valve replacement 1.75 ± 0.34).
SHR values remained independent of HbA1c, with no difference for those with HbA1c above or below 6.5% (p > 0.11 for each). BG however was highly dependent on HbA1c, invariably elevated in those with HbA1c ≥ 6.5% (p < 0.001 for each), and unreliably reflected SIH.
Conclusion
The acute stress response associated with various medical and surgical categories is associated with signature levels of SIH. Those with higher expected SHR are more likely to benefit from early SIH management, especially major surgery, which induced SIH typically 40% greater than medical cohorts. SHR equally recognised the acute change in BG from baseline across the full HbA1c spectrum while BG did not and poorly reflected SIH.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.14930</identifier><identifier>PMID: 35945696</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Aortic valve ; Blood glucose ; Blood Glucose - analysis ; Coronary artery ; Diabetes ; Glycated Hemoglobin - analysis ; HbA1c ; Heart ; Heart surgery ; Hemoglobin ; Hospitalization ; Humans ; Hyperglycemia ; Hyperglycemia - diagnosis ; Medical diagnosis ; Mitral valve ; Myocardial infarction ; Patients ; Sepsis ; Stress ; stress hyperglycaemia ratio ; Stress response ; Stress, Physiological ; stress‐induced hyperglycaemia</subject><ispartof>Diabetic medicine, 2022-10, Vol.39 (10), p.e14930-n/a</ispartof><rights>2022 Diabetes UK.</rights><rights>Diabetic Medicine © 2022 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-3b808d71b6ba475343efc6caf52307e4c68f79d2fa19e7f7eee22358cfb8e6513</citedby><cites>FETCH-LOGICAL-c3530-3b808d71b6ba475343efc6caf52307e4c68f79d2fa19e7f7eee22358cfb8e6513</cites><orcidid>0000-0002-8669-5944</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.14930$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.14930$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35945696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roberts, Gregory W.</creatorcontrib><creatorcontrib>Larwood, Crystal</creatorcontrib><creatorcontrib>Krinsley, James S.</creatorcontrib><title>Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>Aim
Stress‐induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A1c (HbA1c).
Methods
We identified eligible patients for eight medical (n = 892) and eight surgical (n = 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR.
Results
Analysis of variance indicated differing SHR and BG within both the medical (p < 0.0001 for both) and surgical cohort (p < 0.0001 for both). Diagnostic categories were associated with signature levels of SHR that varied between groups. Medically, SHR was greatest for ST‐elevation myocardial infarction (1.22 ± 0.33) and sepsis (1.37 ± 0.43). Surgically, SHR was greatest for colectomy (1.62 ± 0.48) and cardiac surgeries (coronary artery graft 1.56 ± 0.43, aortic valve replacement 1.71 ± 0.33, and mitral valve replacement 1.75 ± 0.34).
SHR values remained independent of HbA1c, with no difference for those with HbA1c above or below 6.5% (p > 0.11 for each). BG however was highly dependent on HbA1c, invariably elevated in those with HbA1c ≥ 6.5% (p < 0.001 for each), and unreliably reflected SIH.
Conclusion
The acute stress response associated with various medical and surgical categories is associated with signature levels of SIH. Those with higher expected SHR are more likely to benefit from early SIH management, especially major surgery, which induced SIH typically 40% greater than medical cohorts. SHR equally recognised the acute change in BG from baseline across the full HbA1c spectrum while BG did not and poorly reflected SIH.</description><subject>Aortic valve</subject><subject>Blood glucose</subject><subject>Blood Glucose - analysis</subject><subject>Coronary artery</subject><subject>Diabetes</subject><subject>Glycated Hemoglobin - analysis</subject><subject>HbA1c</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - diagnosis</subject><subject>Medical diagnosis</subject><subject>Mitral valve</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Sepsis</subject><subject>Stress</subject><subject>stress hyperglycaemia ratio</subject><subject>Stress response</subject><subject>Stress, Physiological</subject><subject>stress‐induced hyperglycaemia</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kbFu2zAQhokiQeO4GfoCBYEsySCHFElRGoPEbQO4KAo0s0BRR5uOJDqkhEBb-wZ5xj5J6NjJYKC33HAfvrvDj9BnSmY01lXdwozygpEPaEJ5xhPBC3qEJkTyNGFE0hN0GsKaEJoWrPiITpgouMiKbIL-_hpU11tjteqt67AzOPQeQvj359l29aChxqtxA37ZjFpBaxVWIThtVR8nT7Zf4QcYcW3VsnOhtxpHESydtxDwEGy3xP0K9s5Dk9_u_ISOjWoCnO37FN1_nf---Z4sfn67u7leJJoJRhJW5SSvJa2ySnEpGGdgdKaVEWn8ELjOciOLOjWKFiCNBIA0ZSLXpsohE5RN0cXOu_HucYDQl60NGppGdeCGUKaSkIynMvqm6PwAXbvBd_G6SFFG8lzQPFKXO0p7F4IHU268bZUfS0rKbS5lzKV8zSWyX_bGoWqhfiffgojA1Q54sg2M_zeVtz_mO-ULcdibCA</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Roberts, Gregory W.</creator><creator>Larwood, Crystal</creator><creator>Krinsley, James S.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8669-5944</orcidid></search><sort><creationdate>202210</creationdate><title>Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio</title><author>Roberts, Gregory W. ; Larwood, Crystal ; Krinsley, James S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-3b808d71b6ba475343efc6caf52307e4c68f79d2fa19e7f7eee22358cfb8e6513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aortic valve</topic><topic>Blood glucose</topic><topic>Blood Glucose - analysis</topic><topic>Coronary artery</topic><topic>Diabetes</topic><topic>Glycated Hemoglobin - analysis</topic><topic>HbA1c</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Hemoglobin</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - diagnosis</topic><topic>Medical diagnosis</topic><topic>Mitral valve</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Sepsis</topic><topic>Stress</topic><topic>stress hyperglycaemia ratio</topic><topic>Stress response</topic><topic>Stress, Physiological</topic><topic>stress‐induced hyperglycaemia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roberts, Gregory W.</creatorcontrib><creatorcontrib>Larwood, Crystal</creatorcontrib><creatorcontrib>Krinsley, James S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roberts, Gregory W.</au><au>Larwood, Crystal</au><au>Krinsley, James S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2022-10</date><risdate>2022</risdate><volume>39</volume><issue>10</issue><spage>e14930</spage><epage>n/a</epage><pages>e14930-n/a</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>Aim
Stress‐induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A1c (HbA1c).
Methods
We identified eligible patients for eight medical (n = 892) and eight surgical (n = 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR.
Results
Analysis of variance indicated differing SHR and BG within both the medical (p < 0.0001 for both) and surgical cohort (p < 0.0001 for both). Diagnostic categories were associated with signature levels of SHR that varied between groups. Medically, SHR was greatest for ST‐elevation myocardial infarction (1.22 ± 0.33) and sepsis (1.37 ± 0.43). Surgically, SHR was greatest for colectomy (1.62 ± 0.48) and cardiac surgeries (coronary artery graft 1.56 ± 0.43, aortic valve replacement 1.71 ± 0.33, and mitral valve replacement 1.75 ± 0.34).
SHR values remained independent of HbA1c, with no difference for those with HbA1c above or below 6.5% (p > 0.11 for each). BG however was highly dependent on HbA1c, invariably elevated in those with HbA1c ≥ 6.5% (p < 0.001 for each), and unreliably reflected SIH.
Conclusion
The acute stress response associated with various medical and surgical categories is associated with signature levels of SIH. Those with higher expected SHR are more likely to benefit from early SIH management, especially major surgery, which induced SIH typically 40% greater than medical cohorts. SHR equally recognised the acute change in BG from baseline across the full HbA1c spectrum while BG did not and poorly reflected SIH.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35945696</pmid><doi>10.1111/dme.14930</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8669-5944</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aortic valve Blood glucose Blood Glucose - analysis Coronary artery Diabetes Glycated Hemoglobin - analysis HbA1c Heart Heart surgery Hemoglobin Hospitalization Humans Hyperglycemia Hyperglycemia - diagnosis Medical diagnosis Mitral valve Myocardial infarction Patients Sepsis Stress stress hyperglycaemia ratio Stress response Stress, Physiological stress‐induced hyperglycaemia |
| title | Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio |
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