assess the relation between glycemic gab and adverse clinical outcomes in diabetic patients who hospitalized with heart failure

Hyperglycemia is a common problem in patients wi9non-diabetic patients but not in patients with diabetes . The relationship between admission hyperglycemia and mortality in diabetic patients with AHF or critical illness remains controversial . Those discrepancies could be partly attributed to long-term glycemic control in diabetic patients.

Critical illness can induce stress-induced hyperglycemia (SIH), which results from the excess release of counter-regulatory hormones and anti-inflammatory cytokines, leading to augmented gluconeogenesis and insulin resistance.

In diabetic patients with acute illness, the phenomenon of admission hyperglycemia could be connected with acute physiological stress, poorer glycemic controls, or a combination of both . It is necessary to think about background glycemic control when exploring the relationships between admissions Hyperglycemia and clinical outcomes. Recent studies have shown that hemoglobin A1c (HbA1c)-based adjusted glycemic variables, including glycemic gap and stress hyperglycemia ratio, were linked to severity of disease and unfavorable prognosis in diabetic patients with some infectious diseases, cardiovascular diseases and clinical illness

Inclusion Criteria:

• All diabetic patients admitted to ICU of internal medicine department from October 2020 to November 2021 by heart failure

Exclusion Criteria:

• Age ≤18 years.

  1. Hypoglycemia (plasma glucose <70 mg/dL) at initial presentation.
  2. An admission diagnosis of diabetic ketoacidosis or hyperosmolar hyperglycemic state.
  3. Patients with hemoglobin variants (e.g., sickle cell anemia, thalassemia) or with hematologic conditions (e.g., hemolytic anemia) that could interfere with the accuracy of the HbA1c assay.

All diabetic patients admitted to ICU of internal medicine department from October 2020 to November 2021 by heart failure