Available online 13 August 2022

Stress hyperglycemia was more detrimental for short-term prognosis than diabetes status for patients older than 75 years

Looser glucose control may be suitable for patients with diabetes older than 75 years

Patients older than 75 years without diabetes may be more likely to benefit from glycemic control

TWAG level of 116.89 mg/dL (6.49 mmol/L) was associated to lower in-hospital mortality in ICU patients without diabetes older than 75 years, taking hypoglycemia and severity of diseases into consideration

To evaluate the effects of diabetes and hyperglycemia on in-hospital mortality in critically ill patients older than 75 years.

This was a single-center retrospective cohort study of patients older than 75 years in the first intensive care unit stay. The patients were divided into four groups: time-weighted average glucose (TWAG) < 140 mg/dL without diabetes (group 1); TWAG ≥ 140 mg/dL without diabetes (group 2); TWAG < 180 mg/dL with diabetes (group 3); TWAG ≥ 180 mg/dL with diabetes (group 4). Clinical and laboratory data were analyzed.

A total of 6760 patients over 75 years of age were included, including 2089 patients previously diagnosed with diabetes. The patients in group 2 had the highest in-hospital mortality (27.4%). In the fully adjusted regression model, the risk of in-hospital mortality increased by 76% (OR = 1.76, 95% CI: 1.49–2.08) in group 2 as compared with group 1. Those from groups 3 and 4 exhibited risks equivalent to the risks of those in group 1; similar results were observed in the subgroup analysis. A J-shaped curve relationship and threshold effect were observed in patients without diabetes. For those with diabetes, a flatter curve pattern with a small slope was observed.

Stress hyperglycemia was more detrimental to short-term prognosis than diabetes status in these patients. Looser glucose control may be suitable for patients older than 75 years with diabetes but unnecessary for those without diabetes. Patients with diabetes may be more resistant to the detrimental effects of glucose variations.

Aged

critically ill

intensive care unit

glucose control

diabetes

mortality

© 2022 Published by Elsevier Inc. on behalf of the AACE.