ArticleJournal of diabetes science and technology2024
The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill.
Article in Journal of diabetes science and technology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 16 citations in OpenAlex.
- Individualising blood glucose control in ICU patients: evidence and practical implementations.Critical care (London, England) · 2026Review
- Artificial pancreas: the past and the future.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2025Review
- The metabolic response to stress in critical illness: updated review on the pathophysiological mechanisms, consequences, and therapeutic implications.Annals of intensive care · 2025Review
- SHRs, biomarkers for dysregulated stress response, predict prognosis in sepsis patients: a retrospective cohort study from MIMIC-IV database.BMC infectious diseases · 2025Article
- Diabetes Technology Meeting 2023.Journal of diabetes science and technology · 2024Article
- Postoperative Length of Stay in Patients With Stress Hyperglycemia Compared to Patients With Diabetic Hyperglycemia: A Retrospective Cohort Study.Journal of diabetes science and technology · 2024Article
- Differential Association between Blood Glucose Levels and Nonrelapse Mortality after Allogeneic Hematopoietic Cell Transplantation Based on Presence or Absence of Preexisting Diabetes.Transplantation and cellular therapy · 2024Article
- Case-control Investigation of Previously Undiagnosed Diabetes in the Critically Ill.Journal of the Endocrine Society · 2022Article
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Authors and funding
9 authors at 8 institutions in 3 countries.
Funding
Abstract
backgroundInterventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality.
methodsRetrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c.
resultsMortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62,
conclusionsThe GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.
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