Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus
Background: We explored the value of admission glycemic gap (AGG) and other glycemic indices in determining the need for mechanical ventilation (MV) among neurocritical patients with diabetes mellitus. Methods: We purposively included 60 adult neurocritical patients with diabetes mellitus and pro...
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Bangabandhu Sheikh Mujib Medical University
2025-05-01
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| Series: | Bangabandhu Sheikh Mujib Medical University Journal |
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| Online Access: | https://www.banglajol.info/index.php/BSMMUJ/article/view/77770 |
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| author | Manas Kanti Mazumder Kazi Tuba-E Mozazfia Mostak Ahmed Mohammad Abdul Hannan AKM Habibullah Montosh Kumar Mondol |
| author_facet | Manas Kanti Mazumder Kazi Tuba-E Mozazfia Mostak Ahmed Mohammad Abdul Hannan AKM Habibullah Montosh Kumar Mondol |
| author_sort | Manas Kanti Mazumder |
| collection | DOAJ |
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Background: We explored the value of admission glycemic gap (AGG) and other glycemic indices in determining the need for mechanical ventilation (MV) among neurocritical patients with diabetes mellitus.
Methods: We purposively included 60 adult neurocritical patients with diabetes mellitus and prospectively studied them for 30 days, or until discharge or death. These patients stayed in the intensive care unit for at least 24 hours and did not require MV within the first twelve hours of admission. The glycemic indices included admission blood glucose level, A1c (HbA1c) level, A1c-derived admission glucose, A1c level, and AGG. The need for initiation of MV was determined according to standard institutional guidelines.
Results: Among the 60 patients enrolled, 39 (65%) required MV. The need for MV was associated with female gender, ischemic stroke, history of insulin use, higher serum creatinine level, lower mean arterial pressure, higher AGG, admission blood glucose level, A1c, and A1c-derived admission glucose. A per unit rise of AGG (odds ratio (OR) 2.1; 95% confidence interval (CI) 1.4–3.1), and A1c (OR 2.6; 95% CI 1.2–5.4) had significant odds for the need for MV. AGG showed an optimal cut off value of 3.2 mmol/L, with a 79% and 81% sensitivity and specificity, respectively. The area under the curve was 0.79 (95% CI 0.66–0.91) for MV.
Conclusion: Among neurocritical patients with diabetes mellitus, all of the evaluated glycemic indices affect the need for MV. The AGG cut-off of 3.2 mmol/L is an acceptable value to predict the need for MV.
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| format | Article |
| id | doaj-art-9291abd2900548c290dcd272a5202c6a |
| institution | DOAJ |
| issn | 2074-2908 2224-7750 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Bangabandhu Sheikh Mujib Medical University |
| record_format | Article |
| series | Bangabandhu Sheikh Mujib Medical University Journal |
| spelling | doaj-art-9291abd2900548c290dcd272a5202c6a2025-08-20T03:12:20ZengBangabandhu Sheikh Mujib Medical UniversityBangabandhu Sheikh Mujib Medical University Journal2074-29082224-77502025-05-0118210.3329/bsmmuj.v18i2.77770Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitusManas Kanti Mazumder0https://orcid.org/0000-0002-7943-7402Kazi Tuba-E Mozazfia1https://orcid.org/0009-0000-1623-2998Mostak Ahmed2https://orcid.org/0000-0001-6143-9488Mohammad Abdul Hannan3https://orcid.org/0009-0006-1949-2756AKM Habibullah4Montosh Kumar Mondol5https://orcid.org/0009-0009-8970-1674Department of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (currently, Bangladesh Medical University), Dhaka, BangladeshDepartment of Intensive Care Unit, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, BangladeshDepartment of Research and Publications, National Institute of Burn and Plastic Surgery, Dhaka, BangladeshDepartment of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (currently, Bangladesh Medical University), Dhaka, BangladeshDepartment of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (currently, Bangladesh Medical University), Dhaka, BangladeshDepartment of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (currently, Bangladesh Medical University), Dhaka, Bangladesh Background: We explored the value of admission glycemic gap (AGG) and other glycemic indices in determining the need for mechanical ventilation (MV) among neurocritical patients with diabetes mellitus. Methods: We purposively included 60 adult neurocritical patients with diabetes mellitus and prospectively studied them for 30 days, or until discharge or death. These patients stayed in the intensive care unit for at least 24 hours and did not require MV within the first twelve hours of admission. The glycemic indices included admission blood glucose level, A1c (HbA1c) level, A1c-derived admission glucose, A1c level, and AGG. The need for initiation of MV was determined according to standard institutional guidelines. Results: Among the 60 patients enrolled, 39 (65%) required MV. The need for MV was associated with female gender, ischemic stroke, history of insulin use, higher serum creatinine level, lower mean arterial pressure, higher AGG, admission blood glucose level, A1c, and A1c-derived admission glucose. A per unit rise of AGG (odds ratio (OR) 2.1; 95% confidence interval (CI) 1.4–3.1), and A1c (OR 2.6; 95% CI 1.2–5.4) had significant odds for the need for MV. AGG showed an optimal cut off value of 3.2 mmol/L, with a 79% and 81% sensitivity and specificity, respectively. The area under the curve was 0.79 (95% CI 0.66–0.91) for MV. Conclusion: Among neurocritical patients with diabetes mellitus, all of the evaluated glycemic indices affect the need for MV. The AGG cut-off of 3.2 mmol/L is an acceptable value to predict the need for MV. https://www.banglajol.info/index.php/BSMMUJ/article/view/77770neurocritical carediabetes mellitusadmission glycemic gapglycemic indicesmechanical ventilation |
| spellingShingle | Manas Kanti Mazumder Kazi Tuba-E Mozazfia Mostak Ahmed Mohammad Abdul Hannan AKM Habibullah Montosh Kumar Mondol Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus Bangabandhu Sheikh Mujib Medical University Journal neurocritical care diabetes mellitus admission glycemic gap glycemic indices mechanical ventilation |
| title | Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| title_full | Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| title_fullStr | Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| title_full_unstemmed | Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| title_short | Admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| title_sort | admission glycemic gap and other glycemic indices in assessing the need for mechanical ventilation among neurocritical patients with diabetes mellitus |
| topic | neurocritical care diabetes mellitus admission glycemic gap glycemic indices mechanical ventilation |
| url | https://www.banglajol.info/index.php/BSMMUJ/article/view/77770 |
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