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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 3  |  Page : 794-800

Study of effect of glycemic gap on adverse outcomes in critically ill patients with diabetes


1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Internal Medicine, Banha Educational Hospital, Banha, Al Qalyubiya, Egypt

Correspondence Address:
Adel A. S. EL Eslam
Department of Internal Medicine, Faculty of Medicine, Yassin Abdel Ghafar street from Gamal Abdel Naser Street, Shebin El Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_16_20

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Objective To study if higher levels of glycemic gap can be used as a tool to predict adverse outcomes in patients with diabetes mellitus admitted with critical illness. Background The glycemic gap is calculated as a difference between the A1C-derived average glucose and the admission glucose and may be a better reflector of outcomes. Patients and methods This study was conducted on 150 patients with type 2 diabetes mellitus who were admitted to the ICUs of Menoufia University Hospitals and Benha Teaching Hospital. Full detailed history, Simplified Acute Physiologic Score II, Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II score, glycated hemoglobin, and glycemic gap were assessed. Results The best cutoff value for prediction of adverse outcomes in critically ill patients with diabetes for random blood sugar on admission was 329, with sensitivity of 98.8% and specificity of 89.5%; glycated hemoglobin was 11.88, with sensitivity of 99% and specificity of 98.3%; A1C-derived average glucose was 295.12, with sensitivity of 98.8% and specificity of 98.3%; glycemic gap was 64.25, with sensitivity of 62.5% and specificity of 60%; Acute Physiology and Chronic Health Evaluation II score was 37.0, with sensitivity of 92.2% and specificity of 90.5%; Simplified Acute Physiologic Score II score was 30, with sensitivity of 90% and specificity of 88.8%; and Sequential Organ Failure Assessment score was 6.0, with sensitivity of 83.3% and specificity of 78.6%. Conclusion Higher glycemic gap levels were significantly associated with an increased risk of multiorgan dysfunction syndrome, acute respiratory distress syndrome, shock, upper gastrointestinal bleed, acute kidney injury, acute respiratory failure, as well as ICU mortality. The glycemic gap is a tool that may be used to assess the severity and prognosis of patients with type 2 diabetes admitted with critical illness.


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