Clinical prediction tool to identify adults with type 2 diabetes at risk for persistent adverse glycemia in hospital

Journal article


Kyi, Mervyn, Gorelik, Alexandra, Reid, Jane, Rowan, Lois M., Paul R. Wraight, Peter G. Colman and Spiros Fourlanos. (2021). Clinical prediction tool to identify adults with type 2 diabetes at risk for persistent adverse glycemia in hospital. Canadian Journal of Diabetes. 45(2), pp. 114-121.e3. https://doi.org/10.1016/j.jcjd.2020.06.006
AuthorsKyi, Mervyn, Gorelik, Alexandra, Reid, Jane, Rowan, Lois M., Paul R. Wraight, Peter G. Colman and Spiros Fourlanos
Abstract

Objectives
Given the high incidence of hyperglycemia and hypoglycemia in hospital and the lack of prediction tools for this problem, we developed a clinical tool to assist early identification of individuals at risk for persistent adverse glycemia (AG) in hospital.

Methods
We analyzed a cohort of 594 consecutive adult inpatients with type 2 diabetes. We identified clinical factors available early in the admission course that were associated with persistent AG (defined as ≥2 days with capillary glucose <4 or >15 mmol/L during admission). A prediction model for persistent AG was constructed using logistic regression and internal validation was performed using a split-sample approach.

Results
Persistent AG occurred in 153 (26%) of inpatients, and was associated with admission dysglycemia (odds ratio [OR], 3.65), glycated hemoglobin ≥8.1% (OR, 5.08), glucose-lowering treatment regimen containing sulfonylurea (OR, 3.50) or insulin (OR, 4.22), glucocorticoid medication treatment (OR, 2.27), Charlson Comorbidity Index score and the number of observed days. An early-identification prediction tool, based on clinical factors reliably available at admission (admission dysglycemia, glycated hemoglobin, glucose-lowering regimen and glucocorticoid treatment), could accurately predict persistent AG (receiver-operating characteristic area under curve = 0.806), and, at the optimal cutoff, the sensitivity, specificity and positive predictive value were 84%, 66% and 53%, respectively.

Conclusions
A clinical prediction tool based on clinical risk factors available at admission to hospital identified patients at increased risk for persistent AG and could assist early targeted management by inpatient diabetes teams.

Keywordsclinical prediction models; hospital; hyperglycemia; hypoglycemia; proactive care; risk factors
Year2021
JournalCanadian Journal of Diabetes
Journal citation45 (2), pp. 114-121.e3
PublisherCanadian Diabetes Association
ISSN1499-2671
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jcjd.2020.06.006
Research or scholarlyResearch
Page range114-121.e3
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online10 Jun 2020
Publication process dates
Accepted03 Jun 2020
Deposited08 Nov 2021
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Clinical feasibility of interactive motion-controlled games for stroke rehabilitation
Bower, Kelly, Louie, Julie, Landesrocha, Yoesph, Seedy, Paul, Gorelik, Alexandra and Bernhardt, Julie. (2015). Clinical feasibility of interactive motion-controlled games for stroke rehabilitation. Journal of NeuroEngineering and Rehabilitation (online). 12, pp. 1 - 12. https://doi.org/10.1186/s12984-015-0057-x
Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis
de Gruchy, Adam, Granger, Catherine L. and Gorelik, Alexandra. (2015). Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis. Physical Therapy. 95(9), pp. 1207 - 1216. https://doi.org/10.2522/ptj.20130552
Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes
Price, Sarah A., Gorelik, Alexandra, Fourlanos, Spiros, Colman, Peter G. and Wentworth, John M.. (2014). Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obesity Research and Clinical Practice. 8(2), pp. e178 - e182. https://doi.org/10.1016/j.orcp.2013.03.007
IDH1 mutation is associated with seizures and protoplasmic subtype in patients with low-grade gliomas
Liubinas, Simon V., D'Abaco, Giovanna M., Moffat, Bradford M., Gonzales, Michael, Feleppa, Frank, Nowell, Cameron J., Gorelik, Alexandra, Drummond, Katharine J., O'Brien, Terence J., Kaye, Andrew H. and Morokoff, Andrew P.. (2014). IDH1 mutation is associated with seizures and protoplasmic subtype in patients with low-grade gliomas. Epilepsia. 55(9), pp. 1438 - 1443. https://doi.org/10.1111/epi.12662
Lifetime risk of total knee replacement and temporal trends in incidence by health care setting, socioeconomic status, and geographic location
Bohensky, Megan A., Ackerman, Ilana, Desteiger, Richard, Gorelik, Alexandra and Brand, Caroline A.. (2014). Lifetime risk of total knee replacement and temporal trends in incidence by health care setting, socioeconomic status, and geographic location. Arthritis Care and Research. 66(3), pp. 424 - 431. https://doi.org/10.1002/acr.22122
Lifetime risk of total hip replacement surgery and temporal trends in utilization: A population-based analysis
Bohensky, Megan A., Ackerman, Ilana, De Steiger, Richard, Gorelik, Alexandra and Brand, Caroline A.. (2014). Lifetime risk of total hip replacement surgery and temporal trends in utilization: A population-based analysis. Arthritis Care and Research. 66(8), pp. 1213 - 1219. https://doi.org/10.1002/acr.22279
Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spas ticity in adults with stroke
Demetrios, Marina, Gorelik, Alexandra, Louie, Julie, Brand, Caroline A., Baguley, Ian J. and Khan, Fary. (2014). Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spas ticity in adults with stroke. Journal of Rehabilitation Medicine. 46(8), pp. 730 - 737. https://doi.org/10.2340/16501977-1842
Drug-induced hepatotoxicity: Incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients
Lin, Jonathan, Moore, David, Hockey, Brad, Di Lernia, Rachel, Gorelik, Alexandra, Liew, Danny and Nicoll, Amanda J.. (2014). Drug-induced hepatotoxicity: Incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients. Liver International. 34(4), pp. 576 - 582. https://doi.org/10.1111/liv.12278
Predictors of health care use among patients with or at high risk of atherothrombotic disease: Two-year follow-up data
Ademi, Zanfina, Liew, Danny, Gorelik, Alexandra, Bohensky, Megan A., Zomer, Ella, Hollingsworth, Bruce, Steg, Gabriel, Bhatt, Deepak L. and Reid, Christopher M.. (2014). Predictors of health care use among patients with or at high risk of atherothrombotic disease: Two-year follow-up data. International Journal of Cardiology. 175(1), pp. 72 - 77. https://doi.org/10.1016/j.ijcard.2014.04.230
Long term follow-up after aortic valve replacement (Ross Procedure): Echocardiographic determinants of ventricular recovery
Wilson, William M., Grigg, Leeanne E., Gorelik, Alexandra and Skillington, Peter. (2014). Long term follow-up after aortic valve replacement (Ross Procedure): Echocardiographic determinants of ventricular recovery. Heart, Lung and Circulation. 23(2), pp. 132 - 143. https://doi.org/10.1016/j.hlc.2013.07.008
Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: A population-based analysis of Victorian hospital separations data
Bohensky, Megan A., Barker, Anna, Morello, Renata Teresa, De Steiger, Richard N., Gorelik, Alexandra and Brand, Caroline A.. (2014). Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: A population-based analysis of Victorian hospital separations data. Internal Medicine Journal. 44(6), pp. 537 - 545. https://doi.org/10.1111/imj.12438
Thyroid surgery and anticoagulation: Survey of practice of endocrine surgeons in Australia
Verma, Kunal Pradip, Gorelik, Alexandra and Miller, Julie A.. (2013). Thyroid surgery and anticoagulation: Survey of practice of endocrine surgeons in Australia. World Journal of Endocrine Surgery. 5(1), pp. 6 - 11. https://doi.org/10.5005/jp-journals-10002-1115
Primary angiitis of the central nervous system: Experience of a Victorian tertiary-referral hospital
Oon, S., Roberts, Carol, Gorelik, Alexandra, Wicks, I. and Brand, Caroline A.. (2013). Primary angiitis of the central nervous system: Experience of a Victorian tertiary-referral hospital. Internal Medicine Journal. 43(6), pp. 685 - 692. https://doi.org/10.1111/imj.12038
Outcomes and excess costs among patients with cardiovascular disease
Ademi, Zanfina, Liew, Danny, Zomer, Ella, Gorelik, Alexandra, Hollingsworth, Bruce, Steg, Philippe Gabriel, Bhatt, Deepak L. and Reid, Christopher M.. (2013). Outcomes and excess costs among patients with cardiovascular disease. Heart, Lung and Circulation. 22(9), pp. 724 - 730. https://doi.org/10.1016/j.hlc.2013.02.002
Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria
Sinclair, M., Roberts, S., Kemp, W., Knight, V., Dev, A., Gow, P., Philpott, H., Kronborg, Ian, Arachchi, Niranjan J., Bell, Sally J., Lim, Lucy, Gorelik, Alexandra and Nicoll, Amanda J.. (2013). Epidemiology of hepatitis B-associated hepatocellular carcinoma in Victoria. Internal Medicine Journal. 43(5), pp. 501 - 506. https://doi.org/10.1111/imj.12068
Who, why and when: Stroke care unit patients seen by a palliative care service within a large metropolitan teaching hospital
Eastman, Peter, McCarthy, Gillian, Brand, Caroline A., Weir, Louise, Gorelik, Alexandra and Le, Brian. (2013). Who, why and when: Stroke care unit patients seen by a palliative care service within a large metropolitan teaching hospital. BMJ Supportive and Palliative Care. 3(1), pp. 77 - 83. https://doi.org/10.1136/bmjspcare-2012-000331