- Chaitanya K Dahagam: United States Army Institute of Surgical Research, Brooke Army Medical Center, San Antonio, Texas, USA.
The purpose of this study was to evaluate glucose control and clinical outcomes in diabetic burn intensive care unit (ICU) patients. The authors reviewed 462 civilian patients admitted to the burn ICU over 4 years. Exclusion criteria were age <18 years, admission because of skin infection, incomplete records, and military patients. Subjects were labeled as diabetic if they had a diagnosis of diabetes documented in their medical records. Otherwise, they were labeled as nondiabetic. Diabetic patients (n = 57) were compared with nondiabetic patients (n = 405). Admission glucose levels were obtained from chemistries. Point-of-care devices provided the remaining glucose values. While in the burn ICU, hyperglycemia for all patients was treated using intensive insulin therapy with a target blood glucose level of 80 to 110 mg/dl. Mann-Whitney U test, χ test, and multivariate regressions were used for statistical analysis (P ≤ .05). Diabetic patients were older (60 ± 15 vs 44 ± 17 years) with higher admission glucose (196 ± 81 vs 133 ± 52 mg/dl), mean glucose (147 ± 37 vs 122 ± 24 mg/dl), glucose variability (30 ± 11 vs 22 ± 11%), and fewer ICU-free days (18 ± 12 vs 20 ± 11). After multivariate regression analyses, age, injury severity score, TBSA, admission glucose, and mean glucose significantly affected the number of ventilator-free days, ICU-free days, and hospital-free days. Glucose variability was associated with hospital-free days only. Age, injury severity score, and TBSA significantly influenced mortality, whereas a preexisting diagnosis of diabetes was not associated with any clinical outcomes. Admission blood glucose is higher, and blood glucose is more difficult to control in diabetic burn ICU patients. A preexisting diagnosis of diabetes does not influence clinical outcomes in critically ill burn patients.