This is an archive article published on January 14, 2021

Blood sugar level fifth vital parameter for good health: Experts

For more than 100 years, temperature, pulse rate, blood pressure and respiratory rate were the four vital signs routinely recorded by doctors and nurses

4 min readPuneUpdated: Jan 16, 2021 08:40 PM IST

A team of scientists who conduct research on diabetes has suggested that level of glucose in blood should be considered as the fifth vital sign in terms general wellbeing for all hospitalized patients, irrespective of whether they have diabetes or not.

The experts have recommended this for all patients regardless of their illness that led them to hospitalisation. For over 100 years so far, four vital signs – temperature, pulse rate, blood pressure and respiratory rate – were routinely recorded by doctors and nurses to decide on a patient’s overall health condition.

The current recommendations, published recently in Diabetes and Metabolic Syndrome: Clinical Research and Reviews, a journal, came from a consensus group which include Padma Shri 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 SR Aravind (President, DiabetesIndia), along with Dr Jothydev Kesavadev (Trivandrum, Kerala), the lead author of the group.

The experts conducted an analysis of around 20 published studies and the recent robust data from Covid-19 hospitalisations around the world, Dr Kesavadev 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 prognosis in any disease, signifying its documentation as an essential part of clinical monitoring, Dr Kesavadev, who is founder chairman and managing director of Jothydev’s Diabetes Research Centres in Trivandrum, Attingal and Kochi, Kerala, explained.

“Despite not being diabetic, some Covid-19 patients, 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 but the patient’s blood sugar levels are 320,” Dr Kesavadev said while explaining how important it was to follow the new recommendation by doctors and nurses in all specialties to reduce the number of days and help bring down cost of treatment in hospitals.

“Taking all details into account, we say it is necessary to have a blood glucose test right at the beginning specially in hospitalised patients regardless of diabetes. Blood glucose needs monitoring especially in patients who are fairly sick,” said Prof Misra who was part of the consensus group.

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“Undiagnosed blood sugar is quite prevalent in India. And the moment when a patient in hospitalised care is under stress, the blood glucose levels go high as many of them are pre-diabetic. It may also come down in some cases or glucose variability may occur,” Prof Mishra added. The team has been working on the research for the last two-three months along with international experts.

It has been conclusively proven that minimal variations in the glucose, both high and low in patients without diabetes and pre-diabetes, significantly increase morbidity, severity and duration of hospital stays. Glucose variability (GV), defined as levels of glucose below and above the acceptable limits, is 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 illness as per the recommendations, it is supposed to drastically bring down the progression to disease severity, number of days in the hospital and overall cost of treatment.

With Jayashree Narayanan in Pune

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Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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