Stress Hyperglycemia Is Associated With an Increased Risk of Subsequent Development of Diabetes Among Bacteremic and Nonbacteremic Patients

Objective: Stress hyperglycemia is associated with an increased risk of diabetes mellitus (DM) among survivors of critical illness. We investigated whether non-diabetic patients hospitalized for bacteremia or non-bacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent DM development, compared to those who remained normoglycemic.

Research design and methods: This retrospective observational study was conducted on 224,534 in-patients with blood culture records. Stress hyperglycemia was defined based on the highest random glucose level ≥ 7.8 mmol/L during the index admission period. Diagnosis of DM, as the primary endpoint of interest, was defined based on diagnostic codes, blood test results or medication records. Differences in cumulative incidence and hazard ratios (HRs) of DM between groups were assessed using Kaplan-Meier estimator and Cox regression.

Results: After exclusion of patients with pre-existing or undiagnosed DM or indeterminate DM status and propensity score-matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of DM (HR: 1.7, 95% CI: 1.2 – 2.4), as compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a DM predictor independent of age, sex, comorbidity, and other serological markers. For the non-bacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of DM (HR: 1.4, 95% CI = 1.2 – 1.7).

Conclusions: Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent DM development, compared to the normoglycemic counterparts. Recognition of an increased risk of DM in these patients can allow early detection and monitoring in their subsequent follow-ups.