Stress-induced hyperglycemia (SH) is frequently observed – during hospitalization due to injury, surgical interventions, critical or acute illnesses. It’s most commonly defined as blood glucose (BG) ≥ 7.8 mmol/l in patients without a history of diabetes mellitus (DM) or established glycated hemoglobin (HbA1c) > 6.5 %. However, some researchers add to this group all patients with hyperglycemia, regardless of their initial diabetic status. Additionally, there is no consensus on the cut-off value of BG which is considered pathological hyperglycemia in critically ill patients. With that in mind as well as the fact that previously undiagnosed DM could be hidden behind SH and that in diabetics hyperglycemia on admission could be the result of poorly controlled DM, difficulties are encountered in using this term.
In order to avoid the influence of patient’s usual BG levels (so-called background glycemia), the concept of relative hyperglycemia has become increasingly popular in recent years as a way to measure SH, as has the use of HbA1c-based glycemic variables. Stress hyperglycemia index, its modified version, as well as glycemic gap, by quantifying relative hyperglycemia, have been shown to be extremely useful, especially in distinguishing stress-induced hyperglycemia from chronically poor diabetes control. A number of studies have found that these glycemic indices have a greater discriminatory power compared to SH for identifying high-risk patients with critical illness. Avoiding the disadvantages of using the absolute value of BG to determine SH, they would be particularly useful in clinical practice, not only for assessing patients' prognosis but also for their therapeutic behavior.
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