The relationship of plasma glucose and glycosylated hemoglobin A1C levels among nondiabetic trauma patients

Objective: Hyperglycemia (blood glucose >= 110 mg/dL) in trauma patients without a known history of diabetes mellitus (DM) is often attributed to the metabolic stress response of injury. We studied whether this hyperglycemia may actually indicate the presence of occult DM (ODM) as demonstrated by elevated glycosylated hemoglobin A(1C) (gHbA(1C)). Methods: After obtaining approval from the Institutional Review Board, a prospective, sequential case series study of nondiabetic adult patients presenting to an urban Level I trauma center from September 2006 to February 2007 was performed. In addition to basic demographics, all hyperglycemic patients had a measured gHbA(1C). ODM was diagnosed when gHbA(1C) was >= 6%. Results: A total of 1,039 trauma patients were screened with 192 (18%) noted to be hyperglycemic. Of these 192 patients, 22% (n = 42) were found to have an elevated gHbA(1C). Using logistic regression, being older (Odds ratio [OR] = 1.04; p < 0.004), having a higher body mass index (BMI) (OR = 1.12; p < 0.003), and being Native American (OR = 5.08; p < 0.017) were each identified as significant risk factors for elevated gHbA(1C) levels and the diagnosis of ODM. In contrast, the magnitude of observed hyperglycemia, gender, or other races were not shown to be significant risk factors for the presence of ODM. Conclusion: Almost a quarter of nondiabetic trauma patients presenting with hyperglycemia were found to have elevated gHbA(1C) levels and ODM. Risk factors for ODM included advancing age and body mass index as well as being Native American. The hyperglycemia seen in trauma patients should not solely be attributed to the hormonal and metabolic response to injury; wider ODM screening for both acute management strategies and long-term health benefits is warranted.