A team of scientists conducting research on diabetes suggested that blood glucose levels should be considered the fifth vital sign in terms of general well-being for all hospitalized patients, regardless of whether they have diabetes or not.
Experts recommended this for all patients, regardless of the illness that led them to hospitalization. For more than 100 years now, four vital signs – temperature, pulse, blood pressure and respiratory rate – have been routinely recorded by doctors and nurses to decide on a patient’s general health.
The current recommendations, recently published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews, a journal, came from a consensus group that includes Padma Shri Prof Anoop Misra (New Delhi), Dr. Akhtar Hussain (Norway, President-Elect, International Federation Diabetes), Dr. Leszek Czupryniak (President, Diabetes Association of Poland), Dr. Itamar Raz (Chief, National Diabetes Council of Israel), Dr. Banshi Saboo (President, RSSDI), Dr. SR Aravind (President, Diabetes India), together with Dr. Jothydev Kesavadev (Trivandrum, Kerala), the group’s lead author.
The experts carried out an analysis of about 20 published studies and the recent robust data from Covid-19 hospitalizations worldwide, Dr. Kesavadev told The Indian Express. Studies to date indicate that blood glucose, in the upper normal ranges, slightly hyperglycemic or hypoglycemic, adversely influences hospital outcomes in people who did not previously have diabetes. This can be particularly important in developing countries, where a considerable number of individuals are at risk of developing hyperglycemia.
Blood glucose is a requirement for the body to maintain normal metabolic processes. Any deviation from the normal blood glucose range can have adverse consequences and contribute to morbidity and mortality. Thus, blood glucose is one of the important parameters for the prognosis in any disease, meaning its documentation as an essential part of clinical monitoring, Dr. Kesavadev, who is the founding president and managing director of the Jothydev Diabetes Research Centers in Trivandrum, Attingal and Kochi, Kerala, explained.
“Although they are not diabetic, some patients with Covid-19, who have moderate or severe disease and use steroids, have been shown to have high blood glucose levels. For example, I am monitoring a 41-year-old Covid-19 patient with no incidence of diabetes, but the patient’s blood sugar levels are 320, “said Dr. Kesavadev in explaining how important it was to follow the new recommendation from doctors and nurses in all specialties to reduce the number of days and help lower the cost of treatment in hospitals.
“Taking into account all the details, we say that it is necessary to have a blood glucose test at the beginning, especially in hospitalized patients regardless of diabetes. Blood glucose needs monitoring, especially in patients who are very sick, ”said Professor Misra, who was part of the consensus group.
“Undiagnosed blood sugar is quite prevalent in India. And the moment an inpatient is under stress, blood glucose levels go up, as many of them are pre-diabetic. It can also decrease in some cases or glucose variability can occur ”, added Prof Mishra. The team has been working on the research for the past two or three months together with international experts.
It is conclusively proven that minimal changes in glucose, high and low in patients without diabetes and with pre-diabetes, significantly increase morbidity, severity and duration of hospital stay. Glucose variability (GV), defined as glucose levels below and above acceptable limits, is directly related to the increased severity of the underlying disease, even in individuals without diabetes.
Routinely around the world, blood glucose is part of the protocol only in individuals with established diabetes. However, if glucose measurement is followed for all diseases according to the recommendations, this should drastically reduce the progression to the severity of the disease, the number of days in the hospital and the overall cost of treatment.
With Jayashree Narayanan in Pune