Glycemic Gap versus Admission Plasma Glucose Level as a Mortality Predictor of ICU Outcomes in Type 2 Diabetic Patients with Acute Heart Failure

Document Type : Original Article

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Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.

Abstract

Background: Hyperglycemia is a prevalent issue among patients experiencing acute heart failure and constitutes an autonomous determinant of short-term mortality among non-diabetic patients but is comparatively insignificant in diabetic patients. Glycemic variables adjusted based on hemoglobin A1c (HbA1c), encompassing the glycemic gap, have been the subject of recent studies. This study evaluates the association between a glycemic gap and unfavorable clinical consequences within diabetic patients hospitalized with AHF.
Patients and Methods: This is a cross-sectional study, which encompassed 140 type-2 diabetic patients who were hospitalized in the intensive care unit at Assiut University during the period from October 2021 to November 2022. These patients met the criteria outlined in the 2021 European Society of Cardiology guidelines for AHF. Calculating the glycemic gap involved subtracting the A1C-derived average glucose (ADAG) level from the admission blood glucose level. The ADAG was determined utilizing the formula: ADAG = 28.7 × HbA1c − 46.72.
Results: Glycemic gap and admission blood glucose level were able to predict all-cause mortality among the studied participants. However, the glycemic gap was superior to admission plasma glucose level with a maximum AUC of 0.71 for all-cause mortality at a cut-off value of ≥ 57mg/dl better than admission blood glucose.
Conclusion: The glycemic gap demonstrated enhanced discriminatory ability in predicting death in patients with diabetes presenting with AHF. Thus, the glycemic gap levels could potentially serve as an indicator of critical illness intensity and overall prognosis in diabetic individuals experiencing AHF.

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