Peter Dodek, MD
What are the benefits and risks of tight glucose control in critically ill adults?
Studies selected compared tight glucose control (glucose goal < 150 mg/dL [8.3 mmol/L], using an insulin infusion) with usual care in patients in adult intensive care units (ICUs) and had one of the outcomes of interest as a primary or secondary endpoint. Outcomes of interest were hospital or 30-day mortality, septicemia (sepsis, septicemia, bacteremia, or positive blood cultures), need for dialysis in patients without prior dialysis, and hypoglycemia (≥ 1 blood glucose measurement ≤ 40 mg/dL [2.2 mmol/L]). Studies of primarily intraoperative interventions or that could not provide adequate outcome or methodological data were excluded.
MEDLINE (1950 to Jun 2008), Cochrane Library (Issue 1, 2008), trial registries (Aug 2007), conference abstracts of American Thoracic Society (2001 to 2008) and Society of Critical Care Medicine (2004 to 2008), and reference lists were searched for randomized controlled trials (RCTs). Trial investigators were contacted for missing data. 34 trials met the selection criteria, including 9 published only as abstracts and 2 that were unpublished. 29 RCTs (n = 8432, mean age 46 to 75 y) that provided full study details and reported ≥ 1 event were included in the meta-analysis. Study quality was modest (Jadad scores ≤ 3 out of 5) because no trials used blinding. All trials had ≥ 80% follow-up (follow-up 28 d to 6 mo, or end of hospital stay), and 2 had group differences in baseline patient characteristics.
Meta-analysis showed that tight glucose control and usual care did not differ for short-term mortality or new need for dialysis (Table). Tight glucose control reduced risk for septicemia but increased risk for hypoglycemia more than usual care (Table).
In critically ill adults, tight glucose control increases risk for hypoglycemia, reduces risk for septicemia, and has no effect on short-term mortality.
Tight glucose control vs usual care in critically ill adults*
*Abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†Glucose ≤ 40 mg/dL (2.2 mmol/L).
Dodek P. Review: Tight glucose control reduces septicemia, but not death, and increases hypoglycemia in critically ill adults. Ann Intern Med. ;150:JC1–5. doi: 10.7326/0003-4819-150-2-200901200-02005
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Published: Ann Intern Med. 2009;150(2):JC1-5.
Infectious Disease, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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