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The optimal target for acute glycemic control in critically ill patients: a network meta-analysis.
Intensive Care Med. 2017 Jan; 43(1):16-28.IC

Abstract

PURPOSE

The optimal target blood glucose concentration for acute glycemic control remains unclear because few studies have directly compared 144-180 with 110-144 or >180 mg/dL. Accordingly, we performed a network meta-analysis to compare four different target blood glucose levels (<110, 110-144, 144-180, and >180 mg/dL) in terms of the benefit and risk of insulin therapy.

METHODS

We included all of the studies from three systematic reviews and searched the PubMed and Cochrane databases for other studies investigating glucose targets among critically ill patients. The primary outcome was hospital mortality, and the secondary outcomes were sepsis or bloodstream infection and the risk of hypoglycemia. Network meta-analysis to identify an optimal target glucose concentration.

RESULTS

The network meta-analysis included 18,098 patients from 35 studies. There were no significant differences in the risk of mortality and infection among the four blood glucose ranges overall or in subgroup analysis. Conversely, target concentrations of <110 and 110-144 mg/dL were associated with a four to ninefold increase in the risk of hypoglycemia compared with 144-180 and >180 mg/dL. However, there were no significant differences between the target concentrations of 144-180 and >180 mg/dL.

CONCLUSIONS

This network meta-analysis found no significant difference in the risk of mortality and infection among four target blood glucose ranges in critically ill patients, but indicated that target blood glucose levels of <110 and 110-144 mg/dL were associated with a higher risk of hypoglycemia than target levels of 144-180 and >180 mg/dL. Further studies are required to refute or confirm our findings.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji, Tokyo, 192-0032, Japan.Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. moriori@tg8.so-net.ne.jp.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

27686353

Citation

Yatabe, Tomoaki, et al. "The Optimal Target for Acute Glycemic Control in Critically Ill Patients: a Network Meta-analysis." Intensive Care Medicine, vol. 43, no. 1, 2017, pp. 16-28.
Yatabe T, Inoue S, Sakaguchi M, et al. The optimal target for acute glycemic control in critically ill patients: a network meta-analysis. Intensive Care Med. 2017;43(1):16-28.
Yatabe, T., Inoue, S., Sakaguchi, M., & Egi, M. (2017). The optimal target for acute glycemic control in critically ill patients: a network meta-analysis. Intensive Care Medicine, 43(1), 16-28. https://doi.org/10.1007/s00134-016-4558-2
Yatabe T, et al. The Optimal Target for Acute Glycemic Control in Critically Ill Patients: a Network Meta-analysis. Intensive Care Med. 2017;43(1):16-28. PubMed PMID: 27686353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The optimal target for acute glycemic control in critically ill patients: a network meta-analysis. AU - Yatabe,Tomoaki, AU - Inoue,Shigeaki, AU - Sakaguchi,Masahiko, AU - Egi,Moritoki, Y1 - 2016/09/29/ PY - 2016/05/23/received PY - 2016/09/13/accepted PY - 2016/10/1/pubmed PY - 2017/11/29/medline PY - 2016/10/1/entrez KW - Critical illness KW - Glycemic control KW - Network meta-analysis KW - Optimal target SP - 16 EP - 28 JF - Intensive care medicine JO - Intensive Care Med VL - 43 IS - 1 N2 - PURPOSE: The optimal target blood glucose concentration for acute glycemic control remains unclear because few studies have directly compared 144-180 with 110-144 or >180 mg/dL. Accordingly, we performed a network meta-analysis to compare four different target blood glucose levels (<110, 110-144, 144-180, and >180 mg/dL) in terms of the benefit and risk of insulin therapy. METHODS: We included all of the studies from three systematic reviews and searched the PubMed and Cochrane databases for other studies investigating glucose targets among critically ill patients. The primary outcome was hospital mortality, and the secondary outcomes were sepsis or bloodstream infection and the risk of hypoglycemia. Network meta-analysis to identify an optimal target glucose concentration. RESULTS: The network meta-analysis included 18,098 patients from 35 studies. There were no significant differences in the risk of mortality and infection among the four blood glucose ranges overall or in subgroup analysis. Conversely, target concentrations of <110 and 110-144 mg/dL were associated with a four to ninefold increase in the risk of hypoglycemia compared with 144-180 and >180 mg/dL. However, there were no significant differences between the target concentrations of 144-180 and >180 mg/dL. CONCLUSIONS: This network meta-analysis found no significant difference in the risk of mortality and infection among four target blood glucose ranges in critically ill patients, but indicated that target blood glucose levels of <110 and 110-144 mg/dL were associated with a higher risk of hypoglycemia than target levels of 144-180 and >180 mg/dL. Further studies are required to refute or confirm our findings. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/27686353/The_optimal_target_for_acute_glycemic_control_in_critically_ill_patients:_a_network_meta_analysis_ L2 - https://dx.doi.org/10.1007/s00134-016-4558-2 DB - PRIME DP - Unbound Medicine ER -