'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 key findings of the study were as follows:
- 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).
- Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability, and less relative hypoglycemia.
- By day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (an absolute difference of 4.6 percentage points).
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.
