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Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality.
Crit Care Med. 2010 Apr; 38(4):1021-9.CC

Abstract

OBJECTIVES

To assess the effect of intensive insulin therapy on blood glucose amplitude variation and pattern irregularity in critically ill patients. To assess the association of these blood glucose signal characteristics with hospital mortality, independent of blood glucose level.

DESIGN

Retrospective analysis of the databases of two previously published randomized controlled trials.

SETTING

University hospital, 56-bed adult surgical intensive care unit and 17-bed medical intensive care unit.

PATIENTS

One thousand five-hundred forty-eight surgical intensive care unit patients, admitted between February 2000 and January 2001, and 1200 medical intensive care unit patients, admitted between March 2002 and May 2005.

INTERVENTIONS

In the two randomized controlled trials, patients were randomized to receive either intensive insulin therapy (targeting normoglycemia, between 4.4 and 6.1 mmol/L) or conventional insulin therapy (infusing insulin when blood glucose levels were >12 mmol/L and stopping at 10 mmol/L).

MEASUREMENTS AND MAIN RESULTS

Intensive insulin therapy significantly lowered mean blood glucose (5.8 vs. 8.4 mmol/L), hyperglycemic index (0.8 vs. 3.2 mmol/L), and glycemic penalty index (26 vs. 53), but it increased the mean daily difference between minimum and maximum blood glucose (mean daily delta blood glucose; 4.0 vs. 3.3 mmol/L). There was no significant effect on the standard deviation of the blood glucose measurements or on jack-knifed approximate entropy. In multivariable logistic regression analysis, corrected for baseline risk factors, blood glucose levels outside the normoglycemic range, higher mean daily delta blood glucose, higher standard deviation blood glucose, and higher jack-knifed approximate entropy were independently associated with hospital mortality.

CONCLUSIONS

The Leuven intensive insulin therapy strategy increased mean daily delta blood glucose while not affecting standard deviation blood glucose and jack-knifed approximate entropy. Increased blood glucose amplitude variation and pattern irregularity were associated with mortality, irrespective of blood glucose level. The reduced mortality observed with intensive insulin therapy in the Leuven trials cannot be attributed to an effect on blood glucose amplitude variation or entropy. Reducing amplitude variation and entropy of the blood glucose signal, irrespective of blood glucose concentration, may produce clinical benefits.

Authors+Show Affiliations

Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium, UK. geert.meyfroidt@uzleuven.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20124887

Citation

Meyfroidt, Geert, et al. "Dynamic Characteristics of Blood Glucose Time Series During the Course of Critical Illness: Effects of Intensive Insulin Therapy and Relative Association With Mortality." Critical Care Medicine, vol. 38, no. 4, 2010, pp. 1021-9.
Meyfroidt G, Keenan DM, Wang X, et al. Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality. Crit Care Med. 2010;38(4):1021-9.
Meyfroidt, G., Keenan, D. M., Wang, X., Wouters, P. J., Veldhuis, J. D., & Van den Berghe, G. (2010). Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality. Critical Care Medicine, 38(4), 1021-9. https://doi.org/10.1097/CCM.0b013e3181cf710e
Meyfroidt G, et al. Dynamic Characteristics of Blood Glucose Time Series During the Course of Critical Illness: Effects of Intensive Insulin Therapy and Relative Association With Mortality. Crit Care Med. 2010;38(4):1021-9. PubMed PMID: 20124887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality. AU - Meyfroidt,Geert, AU - Keenan,Daniel M, AU - Wang,Xin, AU - Wouters,Pieter J, AU - Veldhuis,Johannes D, AU - Van den Berghe,Greet, PY - 2010/2/4/entrez PY - 2010/2/4/pubmed PY - 2010/4/10/medline SP - 1021 EP - 9 JF - Critical care medicine JO - Crit Care Med VL - 38 IS - 4 N2 - OBJECTIVES: To assess the effect of intensive insulin therapy on blood glucose amplitude variation and pattern irregularity in critically ill patients. To assess the association of these blood glucose signal characteristics with hospital mortality, independent of blood glucose level. DESIGN: Retrospective analysis of the databases of two previously published randomized controlled trials. SETTING: University hospital, 56-bed adult surgical intensive care unit and 17-bed medical intensive care unit. PATIENTS: One thousand five-hundred forty-eight surgical intensive care unit patients, admitted between February 2000 and January 2001, and 1200 medical intensive care unit patients, admitted between March 2002 and May 2005. INTERVENTIONS: In the two randomized controlled trials, patients were randomized to receive either intensive insulin therapy (targeting normoglycemia, between 4.4 and 6.1 mmol/L) or conventional insulin therapy (infusing insulin when blood glucose levels were >12 mmol/L and stopping at 10 mmol/L). MEASUREMENTS AND MAIN RESULTS: Intensive insulin therapy significantly lowered mean blood glucose (5.8 vs. 8.4 mmol/L), hyperglycemic index (0.8 vs. 3.2 mmol/L), and glycemic penalty index (26 vs. 53), but it increased the mean daily difference between minimum and maximum blood glucose (mean daily delta blood glucose; 4.0 vs. 3.3 mmol/L). There was no significant effect on the standard deviation of the blood glucose measurements or on jack-knifed approximate entropy. In multivariable logistic regression analysis, corrected for baseline risk factors, blood glucose levels outside the normoglycemic range, higher mean daily delta blood glucose, higher standard deviation blood glucose, and higher jack-knifed approximate entropy were independently associated with hospital mortality. CONCLUSIONS: The Leuven intensive insulin therapy strategy increased mean daily delta blood glucose while not affecting standard deviation blood glucose and jack-knifed approximate entropy. Increased blood glucose amplitude variation and pattern irregularity were associated with mortality, irrespective of blood glucose level. The reduced mortality observed with intensive insulin therapy in the Leuven trials cannot be attributed to an effect on blood glucose amplitude variation or entropy. Reducing amplitude variation and entropy of the blood glucose signal, irrespective of blood glucose concentration, may produce clinical benefits. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/20124887/Dynamic_characteristics_of_blood_glucose_time_series_during_the_course_of_critical_illness:_effects_of_intensive_insulin_therapy_and_relative_association_with_mortality_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181cf710e DB - PRIME DP - Unbound Medicine ER -