CUMULATIVE TIME IN BAND: GLYCEMIC LEVEL, VARIABILITY AND PATIENT OUTCOME vs. MORTALITY

1. CUMULATIVE TIME IN BAND: GLYCEMIC LEVEL, VARIABILITY AND PATIENT OUTCOME vs. MORTALITY Sophie Penning, Matthew Signal, Jean-Charles Preiser, Geoffrey Shaw, Aaron Le Compte, Christopher Pretty, Thomas Desaive, J. Geoffrey Chase Introduction Results • “A higher OR means a better chance of survival” Negative outcomes of dysglycemia are associated with exposure and repetition to high glucose levels, indicating that metrics of exposure might influence outcome. Band 4.0-7.0 mmol/L 5.0-8.0 mmol/L 4.0-8.0 mmol/L Odds ratio Threshold cTIB ≥ 50% Objectives • This research addresses the key questions: • Is glycemic control associated with improved hospital mortality regardless of how it is achieved? • Is there a metric of glycemic control performance or level that can be assessed in real time to adequately discriminate between patient outcomes? cTIB ≥ 60% Methods • Retrospective analysis of data from two glycemic control studies. • Glycemic performance metric: cumulative time in band – cTIB • Analysis by outcome glycemic performance rather than treatment group. cTIB ≥ 70% • “cTIB is the percentage of glucose measurements within a specified band from the start to the present time” • “Yes, and it captures both glycemic level and variability” cTIB ≥ 80% Days of stay • “We investigated three different glycemic bands and four cumulative time in band thresholds” 4.0-7.0 mmol/L 5.0-8.0 mmol/L 4.0-8.0 mmol/L • “A higher threshold level indicates less tolerance for dysglycemia and variability” BG (mmol/L) Conclusions Band • Yes! Glycemic control is associated with improved hospital mortality regardless of how it is achieved. • Yes! there is a metric of glycemic control performance or level that can be assessed in real time to adequately discriminate between patient outcomes. • “A higher cumulative time in band is a associated with a greater chance of survival” Time (hours) Time (hours) Time (hours) cTIB = 2/7 = 29% cTIB = 19/25 = 76% cTIB = 39/49 = 80% BG (mmol/L) cTIB = 51/61 = 84% Odds ratio (OR) = = Time (hours)