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Comment on article: “Association between stress hyperglycemia and in-hospital complications”

How to cite this article: Gracia-Ramos AE. Comment on article: “Association between stress hyperglycemia and in-hospital complications”. Rev Med Inst Mex Seguro Soc. 2015 Jul-Aug;53(4):399.



Comment on article: “Association between stress hyperglycemia and in-hospital complications”

Abraham Edgar Gracia-Ramosa

aDepartamento de Medicina Interna, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México

Communication with: Abraham Edgar Gracia-Ramos

Telephone: (55) 5724 5900, extension 23214


Regarding the article by Galindo-Garcia et al. entitled "Partnership between stress hyperglycemia and hospital complications,"1 the authors mention that "stress hyperglycemia is any elevation of serum glucose at the time of hospital admission in patients with or without diabetes mellitus previously diagnosed". However, according to the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE),2 the Endocrine Society, the American Heart Association (AHA), the American Association of Diabetes Educators (AADE), the European Society of Endocrinology and the Society of Hospital Medicine3 well as by other opinion leader researchers on the subject,4-6 the term "stress hyperglycemia" refers to a transient hyperglycemia during the course of an acute illness and is restricted to patients without evidence of diabetes mellitus.

On the other hand, the most appropriate term for the definition used in the article Galindo-Garcia et al. is "hospital hyperglycemia" or "hyperglycemia in hospitalized patients,"5-7 which refers to any glucose value greater than 140 mg/dL and encompasses the following types of patients: a) with a previous diagnosis of diabetes b) no previous diagnosis of diabetes but carriers of disease c) with stress hyperglycemia.4,6,8 Such differentiation of patients has prognostic value: a retrospective study of medical records of 1,886 patients were analyzed, it was found that those with hyperglycemia newly diagnosed ("stress hyperglycemia") had an increase in mortality of 18.3 times compared with an increase in mortality of 2.7 times shown by patients with a known diabetes diagnosis, even when data were adjusted for age, body mass index, hypertension, coronary artery disease, presence of infection, renal failure and admission to an intensive care unit.9-11 Another retrospective study involving 259,040 patients admitted to the University-affiliated Veterans Affairs Medical Center ( VAMC) showed a significant association between hyperglycemia and adjusted mortality in unstable angina, acute myocardial infarction, congestive heart failure, arrhythmias, ischemic or hemorrhagic cerebral vascular disease, gastrointestinal bleeding, acute kidney injury, pneumonia, pulmonary embolism and sepsis. The risk of death was significantly higher for each quartile of blood glucose in patients without a history of diabetes in the VAMC database. In a prospective study of almost 1,700 patients with acute myocardial infarction a linear association between hyperglycemia and adverse outcomes was demonstrated, especially in non-diabetic individuals.

  1. Galindo-García G, Galván-Plata ME, Nellen-Hummel H, Lmeida-Gutiérrez E. Asociación entre hiperglucemia de estrés y complicaciones intrahospitalarias. Rev Med Inst Mex Seguro Soc 2015;53(1) 6-12.
  2. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Endocr Pract 2009;15(4):1-17.
  3. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglucemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2012;97(1):16-38.
  4. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet 2009;373(9677):1798-1807.
  5. McDonnell ME, Umpierrez GE. Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin North Am 2012;41(1):175-201.
  6. Mikhail N. Management of hyperglycemia in hospitalized noncritical patients. South Med J 2013;106(3):238-244.
  7. American Diabetes Association. Standards or Medical Care in Diabetes – 2015. Diabetes care 2015;38(suppl 1):S1-S93.
  8. Gracia-Ramos AE, Cruz-Dominguez MP, Madrigal-Santillan EO, Morales-González JA, Vera-Lastra OL. Manejo de la hiperglucemia en pacientes hospitalizados. Rev Med Inst Mex Seguro Soc 2015; 53(2):192-199.
  9. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglucemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87(3):978-982.
  10. Falciglia M, Freyberg RW, Almenoff PL, D´Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37(12):3001-3009.
  11. Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 2008;117(8):1018-1027.

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