(277) To Study Association Between Glycemic Gap and Adverse Outcomes in Diabetic Patients Admitted to ICU

Introduction: Glycemic excursions are commonly seen in patients admitted to the Intensive Care Unit (ICU) and are related to adverse outcomes. Glycemic gap is a marker of this excursion in patients with diabetes. It can be used to predict adverse outcomes in patients with diabetes admitted to the ICU. It is calculated by subtracting A1C-derived average glucose (ADAG) = ([28.7 × HbA1c]-46.7) from plasma glucose at admission.

Methods: We conducted an cross sectional study to include patients with type 2 DM admitted to the ICUs from January 2022 to June 2024. The following adverse outcomes were recorded: Multiorgan dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), shock, upper gastrointestinal (UGI) bleed, acute kidney injury (AKI), and acute respiratory failure (ARF).

Results: A total of 100 patients were enrolled, with a mean age ± standard deviation of 51 ± 17 years, and 70% were males. The median (interquartile range) duration of hospital stay and ICU stay were 11 (6-17) days and 7 (3-12) days, respectively. The most common primary diagnosis was cardiovascular (42%) followed by neurological (15%), infection at diagnosis (18%), respiratory (14%), gastrointestinal (8%), and others (3%). A higher glycemic gap was associated with occurrence of MODS (P < 0.01), ARDS (P = 0.028), shock (P = 0.033), UGI bleed (P = 0.016), AKI (P = 0.01), and ARF (P < 0.01). Glycemic gap cutoffs of 45.3, 46.2, and 40.2 were found to be discriminatory for predicting ICU mortality (area under the receiver operating characteristic.

Conclusions: This study showed that higher glycemic gap levels were associated with an increased risk of MODS, ARDS, shock, UGI bleed, AKI, and ARF. Glycemic gap is a tool that can be used to determine prognosis in patients with diabetes admitted to the ICU.