Monday, August 21, 2006

Blood Sugars Can Predict Death in Non-Diabetic Patients with Heart Failure

This week's Archives of Internal Medicine has another reminder of how critical maintaining a normal blood glucose really is as we age. In the study, Admission Blood Glucose Level and Mortality Among Hospitalized Nondiabetic Patients With Heart Failure, researchers sought to understand the significance of blood glucose levels in non-diabetic patients, upon admission to the hospital with heart failure.

The finding is sobering - in hospital mortality (death) is twice as likely in those with high blood sugars compared with those with normal blood sugars. At a baseline normal blood sugar range upon admission for heart failure, each 18mg/dL increase in blood glucose increased the risk of in-hospital death by 31%.

In addition, in those that survived initally in the hospital and were released, the risk of death in the first sixty days following heart failure was also higher in those who had elevated blood sugar at admission for heart failure - an increased risk of 12%. After six months and one-year, there was no risk difference between those non-diabetics with normal or elevated blood sugars at admission.

The researchers concluded that elevated blood sugars in non-diabetic patients is an independent predictor of in-hospital and 60-day mortality.

Our finding calls attention to a new prognostic marker that could be used for early risk stratification and management of patients with HF at hospital admission. It is possible that better glucose control may improve prognosis in hyperglycemic patients with HF, as demonstrated in acute myocardial infarction and critically ill patients. Further research is needed to determine whether hyperglycemia is a marker or cause of adverse outcome and whether immediate, tight glycemic control would confer benefit and improve survival in these high-risk patients.

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