Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 206, Issue 7, Pages 874-882Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.202202-0329OC
Keywords
blood glucose; critical illness; diabetes; hypoglycemia; intensive care
Categories
Funding
- Melbourne Academic Centre for Health Rapid Applied Research Translation Grant
- Diabetes Australia Research Trust
- Royal Australasian College of Physicians Diabetes Australia Research Establishment Fellowship
- Royal Adelaide Hospital Research Committee Project Grant
- Intensive Care Foundation Fisher and Paykel Research Project Grant
- Faculty of Health Sciences Divisional Scholarship
- Royal Adelaide Hospital Research Committee Dawes Top-up Scholarship
- National Health and Medical Research Council (NHMRC) Career Development Fellowship
- HRC
- Health Research Council (HRC)
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This study investigates the effect of blood glucose target range on patient outcomes in ICU patients with type 2 diabetes. The results show that a liberal approach to blood glucose targets can reduce the incidence of hypoglycemia, but does not improve patient-centered outcomes.
Rationale: Blood glucose concentrations affect outcomes in critically ill patients, but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objectives: To evaluate the effects of a liberal approach to targeted blood glucose range during ICU admission. Methods: This mutlicenter, parallel-group, open-label randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. In the intervention group intravenous insulin was commenced at a blood glucose >252 mg/dl and titrated to a target range of 180-252 mg/dl. In the comparator group insulin was commenced at a blood glucose >180 mg/dl and titrated to a target range of 108-180 mg/dl. The primary outcome was incident hypoglycemia (<72 mg/dl). Secondary outcomes included glucose metrics and clinical outcomes. Measurements and Main Results: By Day 28, at least one episode of hypoglycemia occurred in 10 of 210 (5%) patients assigned the intervention and 38 of 209 (18%) patients assigned the comparator (incident rate ratio, 0.21 [95% confidence interval (CI), 0.09 to 0.49]; P < 0.001). Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability, and less relative hypoglycemia (P < 0.001 for all comparisons). By Day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference, 4.6 percentage points [95% CI, -3.9% to 13.2%]; P = 0.29). Conclusions: A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patientcentered outcomes.'
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