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The Impact of Prediabetes on Glycemic Control and Clinical Outcomes Postburn Injury

Somerset, Amy*; Coffey, Rebecca MSN, CNP; Jones, Larry MD; Murphy, Claire V. Pharm D, BCPS

doi: 10.1097/BCR.0b013e3182a2adea
2013 Moyer Award

Poor glucose control and clinical outcomes have been observed in diabetic versus nondiabetic patients postburn injury. Prediabetes is a precursor to diabetes. The purpose of this study was to assess the effects of prediabetes on postinjury glucose control and clinical outcomes. A retrospective review was conducted comparing prediabetics and euglycemic controls. Patients who were admitted for burn care were 18 to 89 years of age and had a hemoglobin A1c (HbA1c) obtained on admission. Prediabetics were defined by an HbA1c of 5.7 to 6.4% and controls by HbA1c < 5.7%. Inpatient glucose levels were recorded, in addition to clinical outcomes. Two hundred eight patients were included: 54 prediabetics and 154 controls. The prediabetic population was older (50.7 vs 39 years; P < .001) with more hypertensives (44.4 vs 16.9%; P < .001), consisted of more African-Americans (20.4 vs 12%; P = .04), and had larger areas of full-thickness burns (4.5 vs 1.75%; P = .02). Median admission HbA1c was 5.9 (5.7–6.0)% among prediabetics and 5.3 (5–5.45)% among controls (P < .001). Prediabetics had significantly higher time-weighted glucose levels (127.7 [105.5–147.6] vs 108.0 [97.1–122.2] mg/dl; P < .001) and more had an average inpatient glucose >150 mg/dl (20.4 vs 9.1%; P = .028). There was no difference in rates of hypoglycemia (glucose <70 mg/dl) or glycemic variability. Prediabetics had lower survival rates (92.6 vs 98.7%; P = .041), but similar rates of unplanned readmission (1.9 vs 3.9%; P = .68), intensive care unit admission (29.6 vs 23.4%; P = .36), mechanical ventilation (24.1 vs 16.2%; P = .20), length of hospital stay (4 [2–8] vs 3 [2–11]; P = .71), and infection (11.1 vs 11.7%; P = .99). Prediabetic status has a significant impact on glucose control and mortality after burn injury.

From the *The Ohio State University College of Medicine, Columbus; and Division of Trauma, Department of Surgery, and Department of Pharmacy, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus.

Address correspondence to Claire V. Murphy, Pharm D, BCPS, Department of Pharmacy, Burn/Surgical Critical Care, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, 368 Doan Hall, Columbus, OH 43210.

© 2014 The American Burn Association