Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database
Background: Time in range (TIR), a glycemic control metric, is increasingly linked to diabetes outcomes. A target of 140–180 mg/dL is recommended for critically ill hyperglycemic patients. Methods: This cohort study analyzed 6,047 critically ill diabetic patients (median age 68, 62.3 % male) from th...
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Elsevier
2025-09-01
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| Series: | Journal of Clinical & Translational Endocrinology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214623725000316 |
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| author | Huimin Ye Zilan Ma Qunchuan Zong Qiang Zhu Yufei Yan Shengmei Yang Pengyue Xiang Huajie Zou |
| author_facet | Huimin Ye Zilan Ma Qunchuan Zong Qiang Zhu Yufei Yan Shengmei Yang Pengyue Xiang Huajie Zou |
| author_sort | Huimin Ye |
| collection | DOAJ |
| description | Background: Time in range (TIR), a glycemic control metric, is increasingly linked to diabetes outcomes. A target of 140–180 mg/dL is recommended for critically ill hyperglycemic patients. Methods: This cohort study analyzed 6,047 critically ill diabetic patients (median age 68, 62.3 % male) from the MIMIC-IV database. TIR (140–180 mg/dL) was defined as the percentage of time within the target glucose range over 24 h. Patients were stratified by TIR quartiles. Outcomes included all-cause mortality, ICU mortality, in-hospital mortality, and 28-day mortality. Cox models assessed TIR-outcomes relationships. Results: Higher TIR correlated with lower mortality. Adjusted HRs for all-cause mortality were 1.00 (Q1), 0.63 (Q2), 0.56 (Q3), and 0.65 (Q4) (p for trend < 0.001). Similar trends were observed for in-hospital mortality (Q4 vs. Q1: HR 0.79, 95% CI: 0.64–0.97). Each 10 % TIR increase reduced all-cause mortality by 8 % (HR 0.92, 95 % CI: 0.88–0.95). Nonlinear dose–response relationships were significant (p < 0.001), with stronger effects in patients < 60, males, and those with myocardial infarction or cancer history (p for interaction < 0.05). Conclusions: Higher TIR (140–180 mg/dL) is associated with reduced mortality in critically ill diabetic patients, suggesting that TIR is a valuable metric for glycemic management in the ICU. |
| format | Article |
| id | doaj-art-b3836d1f4a9047d4a0cbeff65cd7a2f3 |
| institution | Matheson Library |
| issn | 2214-6237 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical & Translational Endocrinology |
| spelling | doaj-art-b3836d1f4a9047d4a0cbeff65cd7a2f32025-07-28T04:16:15ZengElsevierJournal of Clinical & Translational Endocrinology2214-62372025-09-0141100413Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV databaseHuimin Ye0Zilan Ma1Qunchuan Zong2Qiang Zhu3Yufei Yan4Shengmei Yang5Pengyue Xiang6Huajie Zou7Department of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, ChinaDepartment of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, ChinaDepartment of Traumatology and Orthopaedics, The Affiliated Hospital of Qinghai University, Xining, ChinaDepartment of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, China; Department of Endocrinology and Metabolism, Yibin Fifth people’s Hospital, Yibin, ChinaDepartment of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, ChinaDepartment of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, ChinaGeriatric Medicine department, Jingmen people’s Hospital, Jingmen, China; Corresponding author at: Geriatric medicine department, Jingmen People’s Hospital, Jingchu University of Technology Affiliated Jingmen People’s Hospital. No. 39 Xiangshan Avenue, Dongbao District, Jingmen City 448000, Hubei Province, China.Department of Endocrinology and Metabolism, The Affiliated Hospital of Qinghai University, Xining, China; Corresponding author at: Department of Endocrinology and Metabolism, the Affiliated Hospital of Qinghai University, No.29 Tongren Road, Xining 810001, China.Background: Time in range (TIR), a glycemic control metric, is increasingly linked to diabetes outcomes. A target of 140–180 mg/dL is recommended for critically ill hyperglycemic patients. Methods: This cohort study analyzed 6,047 critically ill diabetic patients (median age 68, 62.3 % male) from the MIMIC-IV database. TIR (140–180 mg/dL) was defined as the percentage of time within the target glucose range over 24 h. Patients were stratified by TIR quartiles. Outcomes included all-cause mortality, ICU mortality, in-hospital mortality, and 28-day mortality. Cox models assessed TIR-outcomes relationships. Results: Higher TIR correlated with lower mortality. Adjusted HRs for all-cause mortality were 1.00 (Q1), 0.63 (Q2), 0.56 (Q3), and 0.65 (Q4) (p for trend < 0.001). Similar trends were observed for in-hospital mortality (Q4 vs. Q1: HR 0.79, 95% CI: 0.64–0.97). Each 10 % TIR increase reduced all-cause mortality by 8 % (HR 0.92, 95 % CI: 0.88–0.95). Nonlinear dose–response relationships were significant (p < 0.001), with stronger effects in patients < 60, males, and those with myocardial infarction or cancer history (p for interaction < 0.05). Conclusions: Higher TIR (140–180 mg/dL) is associated with reduced mortality in critically ill diabetic patients, suggesting that TIR is a valuable metric for glycemic management in the ICU.http://www.sciencedirect.com/science/article/pii/S2214623725000316GlycemicControl time in range (TIR)Mortality critical illnessType 2 diabetes |
| spellingShingle | Huimin Ye Zilan Ma Qunchuan Zong Qiang Zhu Yufei Yan Shengmei Yang Pengyue Xiang Huajie Zou Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database Journal of Clinical & Translational Endocrinology Glycemic Control time in range (TIR) Mortality critical illness Type 2 diabetes |
| title | Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database |
| title_full | Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database |
| title_fullStr | Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database |
| title_full_unstemmed | Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database |
| title_short | Association of the time in targeted blood glucose range of 140 to 180 mg/dL with the mortality of critically ill patients with diabetes: analysis of the MIMIC-IV database |
| title_sort | association of the time in targeted blood glucose range of 140 to 180 mg dl with the mortality of critically ill patients with diabetes analysis of the mimic iv database |
| topic | Glycemic Control time in range (TIR) Mortality critical illness Type 2 diabetes |
| url | http://www.sciencedirect.com/science/article/pii/S2214623725000316 |
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