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Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

Authors Yang CJ, Liao WI, Tang ZC, Wang JC, Lee CH, Chang WC, Hsu CW, Tang SE, Tsai SH

Received 28 December 2016

Accepted for publication 10 May 2017

Published 3 July 2017 Volume 2017:12 Pages 1923—1932

DOI https://doi.org/10.2147/COPD.S131232

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Chih-Jen Yang,1 Wen-I Liao,1 Zun-Cheng Tang,2 Jen-Chun Wang,1 Chien-Hsing Lee,3 Wei-Chou Chang,4 Chin-Wang Hsu,5,6 Shih-En Tang,7 Shih-Hung Tsai1

1Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, 2Department of Biological Imaging and Radiological Science, National Yang-Ming University, 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, 4Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 5Department of Emergency Medicine, School of Medicine, College of Medicine, 6Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, 7Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Abstract: Acute hyperglycemia is a common finding in patients presenting to emergency departments (EDs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Several studies have argued against the association between hyperglycemia at admission and adverse outcomes in patients with diabetes and an acute illness. Recent studies have shown that glucose-related variables (eg, glycemic gaps and stress hyperglycemia ratios) that are adjusted for glycated hemoglobin levels can indicate the severity of a variety of diseases. The objective of this study was to assess whether these hemoglobin A1c (HbA1c)-based adjusted average glycemic variables were associated with unfavorable outcomes in patients admitted to a hospital with AECOPD. We found that 1) pulmonary infection is a major risk factor for AECOPD; 2) a higher glycemic gap and modified stress hyperglycemia ratio were associated with the development of acute respiratory failure (ARF) in patients with diabetes admitted to an ED because of AECOPD; and 3) the glycemic gap and modified stress hyperglycemia ratio had superior discriminative power over acute hyperglycemia and HbA1c for predicting the development of ARF, although the HbA1c-adjusted glycemic variables alone were not independent risk factors for ARF.

Keywords: chronic obstructive pulmonary disease, diabetes mellitus, acute respiratory failure, glycated hemoglobin, hyperglycemia, glycemic gap, stress hyperglycemia ratio

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