MANAGEMENT OF HYPERGLYCEMIA IN THE EMERGENCY DEPARTMENT AND ITS IMPACT ON MORTALITY AND ADVERSE OUTCOMES

Introduction: Glycemic control in emergency settings is essential for predicting patient outcomes. Objective: To determine whether glycemic control impacts mortality and clinical outcomes in Peru. Methods: An observational, analytical, retrospective cohort study was conducted in three national hospitals in Metropolitan Lima between August and December 2022. A total of 730 patients aged over 18 years with hyperglycemia (serum glucose >180 mg/dL), with or without a history of diabetes mellitus (DM), were included. Clinical, demographic, and biochemical variables were assessed. Glycemic control was defined as blood glucose ≤180 mg/dL within 24 hours of treatment. The composite outcome included mortality, need for mechanical ventilation, and hemodialysis due to acute kidney injury (AKI). Poisson regression with robust variance was used for multivariate analysis. The study was approved by ethics committees, and data confidentiality was respected. Results: Glycemic control was achieved in 45.2% of patients at 24 hours, which was associated with a lower rate of prolonged hospital stay (51.8% vs. 60.5%; aRR: 0.86; 95% CI: 0.74-0.99; p=0.031). No significant association was found with other outcomes: mechanical ventilation (RR: 1.53; 95% CI: 0.90-2.59; p=0.115), AKI requiring hemodialysis (RR: 0.88; 95% CI: 0.44-1.78; p=0.727), mortality (RR: 1.13; 95% CI: 0.55-2.31; p=0.735), or the composite outcome (RR: 1.07; 95% CI: 0.74-1.55; p=0.724). Similar results were found in the sub-analysis of patients with DM. Conclusion: Early glycemic control reduces the duration of hospital stay but does not impact other clinical outcomes, suggesting the need for a comprehensive and personalized approach.