Ryan J. Jalleh , Cong Xie , Adam M. Deane , Mark P. Plummer , Karen L. Jones , Michael Horowitz , Palash Kar
{"title":"危重疾病和应激性高血糖患者口服葡萄糖负荷75 g后1小时血糖水平及其与胃排空的关系","authors":"Ryan J. Jalleh , Cong Xie , Adam M. Deane , Mark P. Plummer , Karen L. Jones , Michael Horowitz , Palash Kar","doi":"10.51893/2022.3.OA6","DOIUrl":null,"url":null,"abstract":"<div><p><strong>Objective:</strong> A 1-hour plasma glucose level ≥ 8.6 mmol/L in a 75 g oral glucose tolerance test has been strongly associated with increased morbidity and mortality in outpatients without diabetes. Our primary aim was to evaluate the 1-hour plasma glucose level in a 75 g glucose tolerance test in survivors of critical illness with stress hyperglycaemia at 3 months after intensive care unit (ICU) discharge, with the secondary aims to evaluate the 2-hour plasma glucose level, glycated haemoglobin (HbA<sub>1c</sub>), and gastric emptying.</p><p><strong>Design:</strong><em>Post hoc</em> analysis of a single-centre, prospective cohort study.</p><p><strong>Setting:</strong> Single-centre, tertiary referral, mixed medical-surgical ICU.</p><p><strong>Participants:</strong> Consecutively admitted patients aged ≥ 18 years who developed stress hyperglycaemia and survived to hospital discharge were eligible.</p><p><strong>Interventions:</strong> Participants returned at 3 months after ICU discharge and underwent a 75 g oral glucose tolerance test.</p><p><strong>Main outcome measures:</strong> One- and 2-hour post load plasma glucose level, HbA<sub>1c</sub>, and assessment of gastric emptying via an isotope breath test.</p><p><strong>Results:</strong> Thirty-five patients (12 females; mean age, 58.5 years [SD, 10.5]; mean HbA<sub>1c</sub>, 37.4 mmol/mol [SD, 7.0]) attended the followup. In 32/35 patients (91%) the 1-hour post load plasma glucose level was ≥ 8.6 mmol/L. There was a positive correlation between the plasma glucose level at 1 hour <em>(r</em><sup><em>2</em></sup> = 0.21; <em>P</em> = 0.006), but no correlation between the 2-hour glucose level (<em>r</em><sup>2</sup> = 0.006; <em>P</em> = 0.63) and gastric emptying.</p><p><strong>Conclusion:</strong> Glucose intolerance, when defined as 1-hour glucose level ≥ 8.6 mmol/L following a 75 g oral glucose load, persists at 3 months in most survivors of stress hyperglycaemia and is dependent on the rate of gastric emptying. Longitudinal studies to characterise mechanisms underlying dysglycaemia and progression to diabetes in individuals with stress hyperglycaemia are indicated.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"24 3","pages":"Pages 268-271"},"PeriodicalIF":1.4000,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000558/pdfft?md5=421c8b11d93dbb71a3d9302f22984249&pid=1-s2.0-S1441277223000558-main.pdf","citationCount":"0","resultStr":"{\"title\":\"One-hour plasma glucose level after a 75 g oral glucose load and its relationship to gastric emptying in survivors of critical illness and stress hyperglycaemia\",\"authors\":\"Ryan J. Jalleh , Cong Xie , Adam M. Deane , Mark P. Plummer , Karen L. Jones , Michael Horowitz , Palash Kar\",\"doi\":\"10.51893/2022.3.OA6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><strong>Objective:</strong> A 1-hour plasma glucose level ≥ 8.6 mmol/L in a 75 g oral glucose tolerance test has been strongly associated with increased morbidity and mortality in outpatients without diabetes. Our primary aim was to evaluate the 1-hour plasma glucose level in a 75 g glucose tolerance test in survivors of critical illness with stress hyperglycaemia at 3 months after intensive care unit (ICU) discharge, with the secondary aims to evaluate the 2-hour plasma glucose level, glycated haemoglobin (HbA<sub>1c</sub>), and gastric emptying.</p><p><strong>Design:</strong><em>Post hoc</em> analysis of a single-centre, prospective cohort study.</p><p><strong>Setting:</strong> Single-centre, tertiary referral, mixed medical-surgical ICU.</p><p><strong>Participants:</strong> Consecutively admitted patients aged ≥ 18 years who developed stress hyperglycaemia and survived to hospital discharge were eligible.</p><p><strong>Interventions:</strong> Participants returned at 3 months after ICU discharge and underwent a 75 g oral glucose tolerance test.</p><p><strong>Main outcome measures:</strong> One- and 2-hour post load plasma glucose level, HbA<sub>1c</sub>, and assessment of gastric emptying via an isotope breath test.</p><p><strong>Results:</strong> Thirty-five patients (12 females; mean age, 58.5 years [SD, 10.5]; mean HbA<sub>1c</sub>, 37.4 mmol/mol [SD, 7.0]) attended the followup. In 32/35 patients (91%) the 1-hour post load plasma glucose level was ≥ 8.6 mmol/L. There was a positive correlation between the plasma glucose level at 1 hour <em>(r</em><sup><em>2</em></sup> = 0.21; <em>P</em> = 0.006), but no correlation between the 2-hour glucose level (<em>r</em><sup>2</sup> = 0.006; <em>P</em> = 0.63) and gastric emptying.</p><p><strong>Conclusion:</strong> Glucose intolerance, when defined as 1-hour glucose level ≥ 8.6 mmol/L following a 75 g oral glucose load, persists at 3 months in most survivors of stress hyperglycaemia and is dependent on the rate of gastric emptying. Longitudinal studies to characterise mechanisms underlying dysglycaemia and progression to diabetes in individuals with stress hyperglycaemia are indicated.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":\"24 3\",\"pages\":\"Pages 268-271\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2022-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277223000558/pdfft?md5=421c8b11d93dbb71a3d9302f22984249&pid=1-s2.0-S1441277223000558-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223000558\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223000558","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
One-hour plasma glucose level after a 75 g oral glucose load and its relationship to gastric emptying in survivors of critical illness and stress hyperglycaemia
Objective: A 1-hour plasma glucose level ≥ 8.6 mmol/L in a 75 g oral glucose tolerance test has been strongly associated with increased morbidity and mortality in outpatients without diabetes. Our primary aim was to evaluate the 1-hour plasma glucose level in a 75 g glucose tolerance test in survivors of critical illness with stress hyperglycaemia at 3 months after intensive care unit (ICU) discharge, with the secondary aims to evaluate the 2-hour plasma glucose level, glycated haemoglobin (HbA1c), and gastric emptying.
Design:Post hoc analysis of a single-centre, prospective cohort study.
Participants: Consecutively admitted patients aged ≥ 18 years who developed stress hyperglycaemia and survived to hospital discharge were eligible.
Interventions: Participants returned at 3 months after ICU discharge and underwent a 75 g oral glucose tolerance test.
Main outcome measures: One- and 2-hour post load plasma glucose level, HbA1c, and assessment of gastric emptying via an isotope breath test.
Results: Thirty-five patients (12 females; mean age, 58.5 years [SD, 10.5]; mean HbA1c, 37.4 mmol/mol [SD, 7.0]) attended the followup. In 32/35 patients (91%) the 1-hour post load plasma glucose level was ≥ 8.6 mmol/L. There was a positive correlation between the plasma glucose level at 1 hour (r2 = 0.21; P = 0.006), but no correlation between the 2-hour glucose level (r2 = 0.006; P = 0.63) and gastric emptying.
Conclusion: Glucose intolerance, when defined as 1-hour glucose level ≥ 8.6 mmol/L following a 75 g oral glucose load, persists at 3 months in most survivors of stress hyperglycaemia and is dependent on the rate of gastric emptying. Longitudinal studies to characterise mechanisms underlying dysglycaemia and progression to diabetes in individuals with stress hyperglycaemia are indicated.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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