'Liberal' approach to blood sugar control does not improve outcomes in diabetics admitted to ICU: Study

Australia: A 'liberal' approach to blood sugar targets reduces the risk of hypoglycemia but did not enhance patient-centered outcomes in type 2 diabetes patients, researchers state in a recent study in the American Journal of Respiratory and Critical Care Medicine. 

The concentrations of blood glucose affect outcomes in critically ill patients but the optimal target blood glucose range in type 2 diabetes patients is not known. Considering this, Alexis P Poole, Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Adelaide, Australia, and colleagues aimed to investigate the effects of a 'liberal' approach to targeted blood glucose range during admission to the intensive care unit (ICU) in a multicenter, parallel-group, open-label, randomized clinical trial.

The 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, the initiation of intravenous insulin was done at a blood glucose >252 mg/dL and titrated to a target range of 180 to 252 mg/dL. In the comparison group, the commencement of insulin was done at a blood glucose >180 mg/dL and titrated to a target range of 108 to 180 mg/dL.

Incident hypoglycemia (<72 mg/dL) was the study's primary outcome. Glucose metrics and clinical outcomes were the secondary outcomes. 

The researchers conclude, that "a liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes."

Reference:

Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Birardar V, Doherty S, Eastwood G, Finfer S, French CJ, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM; LUCID Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG). The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A multicenter, parallel-group, open-label, randomized clinical trial. Am J Respir Crit Care Med. 2022 May 24. doi: 10.1164/rccm.202202-0329OC. Epub ahead of print. PMID: 35608484.