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Guillermo E. Umpierrez, Abbas E. Kitabchi, Authors’ Response: Hyperglycemia—An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 3, 1 March 2003, Pages 1402–1405, https://doi.org/10.1210/jc.2002-021718
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To the editor:
We appreciate the interest of Dr. Cakir and colleagues in our recent publication regarding in-patient hyperglycemia. Several observational studies have shown that admission hyperglycemia in patients without diabetes is associated with increased morbidity and mortality during critical illnesses (1–5). Similarly, several intervention studies in acutely ill patients have shown that control of hyperglycemia significantly reduces the rate of complications and risk of death (6–8). This evidence strongly suggests that hyperglycemia is associated with adverse outcomes for hospitalized patients with and without diabetes and that improvement in outcome can be achieved with improved glycemic control (9). The major findings of our study are that hyperglycemia was present in 38% of patients admitted to the hospital, of whom one third had no history of diabetes before the admission, and that newly discovered hyperglycemia was associated with higher in-hospital mortality rate and lower functional outcome not only in critically ill patients admitted to the Intensive Care Unit (ICU) but also in patients admitted to general medicine or surgical wards. We agree with Dr. Cakir's comments that a number of features suggest that patients with new hyperglycemia are under more severe stress and had a more severe illness as indicated by a higher rate of ICU admission, a longer length of hospital stay, and the increased referral rate to an extended care facility after discharge. Further research should focus on the optimal management of hyperglycemia in patients admitted to both the ICU and the general medicine and surgical wards.
