Blood Glucose to be considered as the fifth vital sign in medicine

A team of International Diabetes Research scientists have recommended Blood Glucose measurements to be considered as the fifth vital sign in all patients admitted in the hospital; irrespective of whether they have diabetes or not. This recommendation is for all the patients whatever the illness responsible for hospital admission be. For more than 100 years, temperature, pulse rate, blood pressure and respiratory rate were the four vital signs routinely recorded by doctors and nurses.

The current recommendations published recently in Diabetes and Metabolic Syndrome: Clinical Research and Reviews is from a consensus group which include Padmasree Prof. Anoop Misra (New Delhi), Dr.Akhtar Hussain (Norway, President Elect, International Diabetes Federation), Dr. Leszek Czupryniak (President, Poland Diabetes Association), Dr.Itamar Raz (Head, Israel National Council of Diabetes), Dr. Banshi Saboo (President, RSSDI), Dr.S.R Aravind (President, DiabetesIndia) alongwith Dr Jothydev Kesavadev (Trivandrum, Kerala), the lead author of the group.

The experts did an analysis of around 20 published studies and the recent robust data from COVID-19 hospitalisations around the world, Dr Jothydev told The Indian Express. Studies till date indicate that blood glucose, in the upper normal, mildly hyperglycemic, or hypoglycemic ranges adversely influences hospital outcomes in those not known to have diabetes previously. This may be particularly important in developing countries where a considerable number of individuals are at risk for developing hyper-glycemia.

Blood glucose is a requisite for the body to maintain normal metabolic processes. Any deviation from the normal range of blood glucose may have adverse consequences and contributes to morbidity and mortality. Thus, blood glucose is one of the important parameters for the prognosis in any disease; signifying its documentation as an essential part of clinical monitoring, Dr Jothydev, who is founder chairman and managing director of Jothydev’s Diabetes Research Centres in Trivandrum, Attingal and Kochi, Kerala explained.

“For instance , despite not being diabetic, some of the patients with Covid 19 who have moderate or severe illness and are on steroids have shown to have high blood glucose levels. For instance, I am monitoring a 41-year-old Covid-19 patient with no incidence of diabetes and blood sugar levels are 320,” Dr Jothydev said while explaining how important it was to follow the new recommendation by doctors and nurses in all specialities to reduce number of days and help bring down cost of treatment in the hospital.

It has been conclusively proven that minimal variations in the glucose both high and low in patients without diabetes and prediabetes significantly increase morbidity, severity and duration of hospital stays. Glucose variability (GV) defined as levels of glucose below and above the acceptable limits are found to be directly related to increasing severity of the underlying disease even in subjects without diabetes. Routinely all over the world, blood glucose is part of the protocol only in those subjects with established diabetes. However, if measurement of glucose is followed for all the illness as in the recommendations it is supposed to drastically bring down the progression to diabetes severity, number of days in the hospital and overall cost of treatment.

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