ABSTRACT
Hyperglycemia in patients receiving nutrition support may be due to type-1 diabetes (T1DM), type-2 diabetes (T2DM), or stress hyperglycemia (SH). Stress hyperglycemia is defined as the presence of elevated glucose during an acute illness, in a patient without a prior diagnosis of diabetes, which normalizes after the illness. The majority of patients who receive nutrition support are hospitalized patients with acute illnesses in whom the need for nutrition support is temporary. A retrospective chart review of 1886 consecutive hospital admissions demonstrated hyperglycemia, defined as a fasting plasma glucose of > 126 mg/dL or random plasma glucose of > 200 mg/dL, in 38% of patients [1]. Of the patients that were hyperglycemic, 68% were known to have diabetes and 32% were hyperglycemic without a prior history of diabetes. In a study by Levetan et al. [2], 37.5% of medical and 33% of surgical admissions with hyperglycemia, defined as a glucose level > 200 mg/dL, did not have a prior diagnosis of diabetes. This latter group consists of patients with undiagnosed T2DM and SH. Compared with patients previously diagnosed with diabetes, patients with SH have a higher in-hospital mortality rate despite a lower average blood glucose level [1]. This suggests that new hyperglycemia in hospitalized patients may be an indicator of more severe stress.
