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Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: An Exploratory Safety Cohort Assessment.
Crit Care Med. 2016 Sep; 44(9):1683-91.CC

Abstract

OBJECTIVES

To assess the feasibility, safety, and impact on relative hypoglycemia of liberal versus conventional blood glucose concentration targets in critically ill diabetic patients.

DESIGN

Prospective, open-label, sequential-period exploratory study.

SETTING

A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia.

PATIENTS

Eighty adult diabetic patients, 40 from the conventional before period and 40 from the liberal after period.

INTERVENTIONS

Blood glucose concentration targets were 6-10 mmol/L during the before period and 10-14 mmol/L during the after period.

MEASUREMENTS AND MAIN RESULTS

We used admission glycated hemoglobin to estimate premorbid baseline blood glucose concentration. We defined glycemic distance as the difference between blood glucose concentration in ICU and baseline blood glucose concentration. During the first 48 ICU hours, we recorded absolute (blood glucose concentration, < 3.9 mmol/L) and relative (glycemic distance, > 30% below baseline) hypoglycemia rates, insulin administration, and outcomes. The groups had similar baseline characteristics. We observed a negative glycemic distance in 248 of 488 blood glucose concentrations (50.8%) during the before period and 164 of 485 (33.8%) during the after period (p < 0.001). We detected relative hypoglycemia in 20 (50.0%) and nine (22.5%) patients in the before and after periods, respectively (p = 0.01). On day 1, 50.0% and 16.7% received insulin in the before and after periods (p = 0.007). ICU and hospital length of stay and mortality were similar between groups.

CONCLUSIONS

In a safety cohort of critically ill diabetic patients, a blood glucose concentration target of 10-14 mmol/L resulted in fewer episodes of negative glycemic distance or relative hypoglycemia and reduced insulin administration compared with a target of 6-10 mmol/L.

Authors+Show Affiliations

1Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.2Department of Anesthesia and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Roma, Italy.3Department of Perioperative Medicine, Intensive Care and Emergency, Università degli Studi di Trieste, Ospedale di Cattinara, Trieste, Italy.4Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia.5Department of Intensive Care, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.6Department of Endocrinology and Diabetology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.7Department of Medicine Austin Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia.8Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solnavägen, Solna, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27046086

Citation

Di Muzio, Francesca, et al. "Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: an Exploratory Safety Cohort Assessment." Critical Care Medicine, vol. 44, no. 9, 2016, pp. 1683-91.
Di Muzio F, Presello B, Glassford NJ, et al. Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: An Exploratory Safety Cohort Assessment. Crit Care Med. 2016;44(9):1683-91.
Di Muzio, F., Presello, B., Glassford, N. J., Tsuji, I. Y., Eastwood, G. M., Deane, A. M., Ekinci, E. I., Bellomo, R., & Mårtensson, J. (2016). Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: An Exploratory Safety Cohort Assessment. Critical Care Medicine, 44(9), 1683-91. https://doi.org/10.1097/CCM.0000000000001742
Di Muzio F, et al. Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: an Exploratory Safety Cohort Assessment. Crit Care Med. 2016;44(9):1683-91. PubMed PMID: 27046086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: An Exploratory Safety Cohort Assessment. AU - Di Muzio,Francesca, AU - Presello,Barbara, AU - Glassford,Neil J, AU - Tsuji,Isabela Y, AU - Eastwood,Glenn M, AU - Deane,Adam M, AU - Ekinci,Elif I, AU - Bellomo,Rinaldo, AU - Mårtensson,Johan, PY - 2016/4/6/entrez PY - 2016/4/6/pubmed PY - 2017/6/1/medline SP - 1683 EP - 91 JF - Critical care medicine JO - Crit Care Med VL - 44 IS - 9 N2 - OBJECTIVES: To assess the feasibility, safety, and impact on relative hypoglycemia of liberal versus conventional blood glucose concentration targets in critically ill diabetic patients. DESIGN: Prospective, open-label, sequential-period exploratory study. SETTING: A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia. PATIENTS: Eighty adult diabetic patients, 40 from the conventional before period and 40 from the liberal after period. INTERVENTIONS: Blood glucose concentration targets were 6-10 mmol/L during the before period and 10-14 mmol/L during the after period. MEASUREMENTS AND MAIN RESULTS: We used admission glycated hemoglobin to estimate premorbid baseline blood glucose concentration. We defined glycemic distance as the difference between blood glucose concentration in ICU and baseline blood glucose concentration. During the first 48 ICU hours, we recorded absolute (blood glucose concentration, < 3.9 mmol/L) and relative (glycemic distance, > 30% below baseline) hypoglycemia rates, insulin administration, and outcomes. The groups had similar baseline characteristics. We observed a negative glycemic distance in 248 of 488 blood glucose concentrations (50.8%) during the before period and 164 of 485 (33.8%) during the after period (p < 0.001). We detected relative hypoglycemia in 20 (50.0%) and nine (22.5%) patients in the before and after periods, respectively (p = 0.01). On day 1, 50.0% and 16.7% received insulin in the before and after periods (p = 0.007). ICU and hospital length of stay and mortality were similar between groups. CONCLUSIONS: In a safety cohort of critically ill diabetic patients, a blood glucose concentration target of 10-14 mmol/L resulted in fewer episodes of negative glycemic distance or relative hypoglycemia and reduced insulin administration compared with a target of 6-10 mmol/L. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/27046086/Liberal_Versus_Conventional_Glucose_Targets_in_Critically_Ill_Diabetic_Patients:_An_Exploratory_Safety_Cohort_Assessment_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001742 DB - PRIME DP - Unbound Medicine ER -