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

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

Acknowledgments

This study was supported by a grant from the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (TSGH-C106-048) and Ministry of Science and Technology, Taiwan (MOST-104-2314-B-106-043-MY2).

Author contributions

CJY had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. CHL, SET, CWH, and SHT contributed to the study design; JCW and SHT contributed to the literature review and writing of the manuscript; WCC and ZCT contributed to the data collection; CJY contributed to the statistical analysis. All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.