Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study.
Mark P Plummer, Louise Rait, Mark E Finnis and 9 others
PMID 35820985WHAT IT FOUND
In Australian ICUs, patients with diabetes or stress-induced hyperglycaemia had much longer stays than normoglycaemic patients.
Mortality was not significantly higher for either group after adjusting for age and illness severity. Routine corticosteroid use worsened glucose control.
Key findings
01After adjusting for age and illness severity, neither stress-induced hyperglycaemia nor diabetes was significantly associated with hospital mortality.
02Patients with stress-induced hyperglycaemia or diabetes were significantly slower to be discharged alive from the ICU compared to normoglycaemic patients.
03Following the introduction of routine corticosteroids, mean blood glucose and glycaemic variability increased significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was underpowered to detect a difference in mortality due to the small sample size (136 patients) and the relatively low overall mortality rate in this Australian cohort. The cohort was drawn from only four hospitals in Melbourne, representing just 27% of Australian ICU admissions, so the results may not be generalisable to the wider Australian or international population. HbA1c data were available for only 42% of patients, leading to potential misclassification of undiagnosed diabetes as stress-induced hyperglycaemia. The study did not account for vaccination status, although the period captured was largely pre-vaccination in Australia. Data on diabetes subtype, duration, and specific glucose-lowering medications were not available.
Declared interests
None declared. The study was supported by funding from the Australian Department of Health.
The easy way to misread this
Do not interpret the lack of significant association between diabetes/stress hyperglycaemia and mortality as evidence that these conditions are benign in critical illness. The study was underpowered for mortality, and the significant increase in ICU length of stay demonstrates a substantial impact on patient recovery and resource use.