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Type: Journal article
Title: Stress induced hyperglycemia and the subsequent risk of type 2 diabetes in survivors of critical illness
Author: Plummer, M.P.
Finnis, M.E.
Phillips, L.K.
Kar, P.
Bihari, S.
Biradar, V.
Moodie, S.
Horowitz, M.
Shaw, J.E.
Deane, A.M.
Citation: PLoS One, 2016; 11(11):e0165923-12-e0165923-12
Publisher: Public Library of Science
Issue Date: 2016
ISSN: 1932-6203
Editor: Pietropaolo, M.
Statement of
Mark P. Plummer, Mark E. Finnis, Liza K. Phillips, Palash Kar, Shailesh Bihari, Vishwanath Biradar, Stewart Moodie, Michael Horowitz, Jonathan E. Shaw, Adam M. Deane
Abstract: OBJECTIVE: Stress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness. DESIGN: Retrospective cohort study. SETTING: All adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011. PATIENTS: Stress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression. MAIN RESULTS: Stress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness. CONCLUSIONS: Stress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.
Keywords: Humans
Diabetes Mellitus, Type 2
Critical Illness
Blood Glucose
Risk Factors
Retrospective Studies
Age Factors
Aged, 80 and over
Middle Aged
Intensive Care Units
Stress, Physiological
Young Adult
Kaplan-Meier Estimate
Rights: Copyright: © 2016 Plummer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI: 10.1371/journal.pone.0165923
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