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
Negative outcomes of dysglycemia are associated with exposure and repetition to high
glucose levels, indicating that metrics of exposure might influence outcome.
Introduction
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?
Objectives
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.
Methods
0 6 12 18 24 30 36 42 48 54 60 0 1 2 3 4 5 6 7 8 9 10 11 12 13 cTIB = 2/7 = 29% cTIB = 19/25 = 76% cTIB = 39/49 = 80% B G ( m m o l/ L) Time (hours) cTIB = 51/61 = 84%“cTIB is the percentage of glucose measurements within a specified band from the start to the present
time”
“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”
“Yes, and it captures both glycemic level
and variability”
Days of stay
O
d
d
s
ra
ti
o
Band
4.0-7.0 mmol/L 5.0-8.0 mmol/L 4.0-8.0 mmol/L
Th
re
sh
o
ld
cT IB ≥ 5 0 % cT IB ≥ 8 0 % cT IB ≥ 7 0 % cT IB ≥ 6 0 %“We investigated three different glycemic bands and four cumulative time in band
thresholds”
“We investigated three different glycemic bands and four cumulative time in band
thresholds” indicates less tolerance for “A higher threshold level
dysglycemia and variability”
“A higher threshold level indicates less tolerance for dysglycemia and variability”
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.
Conclusions
Lived Died cTIB ≥ t N1 N2 cTIB < t N3 N4
“A higher OR means a better chance of
survival”
“A higher OR means a better chance of
survival”
SPRINT Glucontrol All
Number of patients 784 933 1717 Percentage of males 61.2 63.2 62.3
Age of patients 65.0 [52.0 - 74.0] 65.2 [51.5 - 74.0] 65.0 [51.8 - 74.0] APACHE 2 score 18.0 [15.0 - 24.0] 15.0 [11.0 - 21.0] 17.0 [13.0 - 23.0] Cohort BG (mmol/L) 6.2 [5.3 - 7.4] 6.9 [5.8 - 8.4] 6.6 [5.6 - 8.1] Per-patient median BG (mmol/L) 6.3 [5.6 - 7.5] 6.9 [6.1 - 8.2] 6.6 [5.8 - 7.9] %BG in 4-7 mmol/L 66.8 49.8 56.4
Odds of living given cTIB ≥ t Odds of living given cTIB < t
N1 N4 N2 N3
Odds ratio (OR) = =
0 12 24 36 48 60 72 84 96 108 120 132 144 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Time (hours) 4.0-7.0 mmol/L 0 12 24 36 48 60 72 84 96 108 120 132 144 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Time (hours) 5.0-8.0 mmol/L 0 12 24 36 48 60 72 84 96 108 120 132 144 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Time (hours) 4.0-8.0 mmol/L B G ( m m o l/ L)
Results
Band
“A higher cumulative time in band is a associated with a greater chance of survival”
“A higher cumulative time in band is a associated with a greater chance of survival”
