Glucose dysregulation in hospitalized non-critically ill patients with a suspected infection: A prospective study using continuous glucose monitoring

Abstract

Introduction Dysglycaemia, defined as hypo- or hyperglycaemia, can occur during infection and is associated with worse outcomes during hospitalization. Previous studies on dysglycaemia in non-critically ill patients on general wards used point-of-care (POC) capillary measurements, possibly underestimating the problem. We assessed the prevalence and course of dysglycaemia in this population using continuous glucose monitoring (CGM). Methods In this prospective, observational study at the University Medical Center Groningen, adults admitted to the Emergency Department with suspected infections were enrolled via the Acutelines data and biobank. Participants wore blinded CGM sensors (FreeStyle Libre Pro iQ) while continuing usual care. Episodes of dysglycaemia were defined as ≥15 minutes of glucose <3.9 mmol/L or >10 mmol/L. Primary outcome was the number of dysglycaemic episodes; secondary outcomes included duration, glucose levels, and associations with clinical outcomes. Results CGM data from 90 participants (27% with a history of diabetes and 73% without) over a median of 3.4 days revealed 181 hyperglycaemia and 303 hypoglycaemia episodes. In patients with a history of diabetes, 75% experienced hyperglycaemia (median of 6.5 events/patient). In contrast, 33% of individuals without prior diabetes experienced hyperglycaemia (median 1.5 events/ patient). Median Time in Range (glucose 3.9–10.0 mmol/L) was 59% for patients with and 86% for patients without known diabetes. Exploratory analyses showed no significant association between dysglycaemia and ICU admission or 30-day mortality. Conclusions This observational study provides relevant insight into dysglycaemia among non-critically ill patients admitted to the hospital. Significant hyperglycaemia was observed in both participants with and without known diabetes. Therefore, CGM may enable earlier detection of dysglycaemia and thereby inform future interventional research and in-hospital strategies.