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

Abstract

OBJECTIVE Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent diabetes development compared with 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 diabetes, as the primary end point of interest, was defined based on diagnostic codes, blood test results, or medication records. Differences in cumulative incidence and hazard ratios (HRs) of diabetes between groups were assessed using the Kaplan-Meier estimator and Cox regression. RESULTS After exclusion of patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and propensity score matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of diabetes (HR 1.7, 95% CI 1.2–2.4) compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a diabetes predictor independent of age, sex, comorbidity, and other serological markers. For the nonbacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of diabetes (HR 1.4, 95% CI 1.2–1.7). CONCLUSIONS Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent diabetes development compared with their normoglycemic counterparts. Recognition of an increased risk of diabetes in these patients can allow early detection and monitoring in their subsequent follow-ups.