Examining the relationship and utility of insulin resistance and glycemic variability to predict mortality and infection in adults with burn injuries

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Severe burn injury results in critical illness accompanied by hypermetabolism and hyperglycemia. Most burn centers balance glycemic control while attempting to avoid adverse hypoglycemic events. The lack of studies explicitly examining the nuances of glycemic control in burns remains a problem. The purpose of this study was to investigate the relationship between glucose control, insulin resistance, glycemic variability, and outcomes in patients with burn injury. Specifically, the researcher examined the ability of glucose control (GC), glycemic variability (GV), and insulin resistance (IR) to predict mortality, infectious complications, length of stay, and discharge disposition. The Neuman Systems Model was used as a theoretical framework to guide this research. A retrospective review of medical records at a verified burn center aimed to assess the correlation of glucose control, insulin resistance, and glycemic variability with outcomes in a population of critically ill adults with greater than 20% TBSA burns over the last five years. Using a stepwise approach to control for Baux score, the mean (p = 0.025), minimum (p = 0.004), maximum (p = 0.028), morning (p = 0.010), and delta (p = 0.012) of glucose levels were significant predictors of mortality. The morning glucose (p = 0.043) and percentage of time within the glucose target range (p = 0.017) were predictive of discharge disposition. The maximum (p <0.001), minimum (p <0.001), and delta (p < 0.001) of glucose values, as well as the total number of insulin doses (p= 0.017), were predictive of length of stay. Measures of glucose control can predict death, length of stay, and discharge disposition. Glycemic variability and insulin resistance were less important in predicting outcomes than glucose control alone. Patients with diabetes have marked difficulty in achieving glucose control, and these patients have the most apparent challenges with glycemic variability and insulin resistance.

Burns, Glycemic variability, Insulin resistance, Glucose control, Hyperglycemia