Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/102412
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Liberal glycemic control in critically Ill patients with type 2 diabetes: an exploratory study
Author: Kar, P.
Plummer, M.
Bellomo, R.
Jenkins, A.
Januszewski, A.
Chapman, M.
Jones, K.
Horowitz, M.
Deane, A.
Citation: Critical Care Medicine, 2016; 44(9):1695-1703
Publisher: Lippincott Williams & Wilkins
Issue Date: 2016
ISSN: 0090-3493
1530-0293
Statement of
Responsibility: 
Palash Kar, Mark P. Plummer, Rinaldo Bellomo, MD, Alicia J. Jenkins, Andrzej S. Januszewski, Marianne J. Chapman, Karen L. Jones, Michael Horowitz, Adam M. Deane
Abstract: Objectives: The optimal blood glucose target in critically ill patients with preexisting diabetes and chronic hyperglycemia is unknown. In such patients, we aimed to determine whether a “liberal” approach to glycemic control would reduce hypoglycemia and glycemic variability and appear safe. Design: Prospective, open-label, sequential-period exploratory study. Setting: Medical-surgical ICU. Patients: During sequential 6-month periods, we studied 83 patients with preexisting type 2 diabetes and chronic hyperglycemia (glycated hemoglobin, ≥ 7.0% at ICU admission). Intervention: During the “standard care” period, 52 patients received insulin to treat blood glucose concentrations greater than 10 mmol/L whereas during the “liberal” period, 31 patients received insulin to treat blood glucose concentrations greater than 14 mmol/L. Measurements and Main Results: Time-weighted mean glucose concentrations and the number and duration of moderate (< 4.0 mmol/L) and severe (≤ 2.2 mmol/L) hypoglycemic episodes were recorded, with moderate and severe hypoglycemic episodes grouped together. Glycemic variability was assessed by calculating the coefficient of variability for each patient. Safety was evaluated using clinical outcomes and plasma concentrations of markers of inflammation, glucose-turnover, and oxidative stress. Mean glucose (TWglucoseday 0–7, standard care: 9.3 [1.8] vs liberal: 10.3 [2.1] mmol/L; p = 0.02) and nadir blood glucose (4.4 [1.5] vs 5.5 [1.6] mmol/L; p < 0.01) were increased during the liberal period. There was a signal toward reduced risk of moderate-severe hypoglycemia (relative risk: liberal compared with standard care: 0.47 [95% CI, 0.19–1.13]; p = 0.09). Ten patients (19%) during the standard period and one patient (3%) during the liberal period had recurrent episodes of moderatesevere hypoglycemia. Liberal therapy reduced glycemic variability (coefficient of variability, 33.2% [12.9%] vs 23.8% [7.7%]; p < 0.01). Biomarker data and clinical outcomes were similar. Conclusions: In critically ill patients with type 2 diabetes and chronic hyperglycaemia, liberal glycemic control appears to attenuate glycemic variability and may reduce the prevalence of moderate-severe hypoglycemia.
Keywords: Humans; Diabetes Mellitus, Type 2; Hyperglycemia; Hypoglycemia; Chronic Disease; Critical Illness; Insulin; Blood Glucose; Hypoglycemic Agents; Critical Care; Prospective Studies; Aged; Middle Aged; Female; Male; Controlled Before-After Studies; Glycated Hemoglobin A
Rights: Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
RMID: 0030049684
DOI: 10.1097/CCM.0000000000001815
Published version: http://ovidsp.tx.ovid.com/sp-3.22.1b/ovidweb.cgi?QS2=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
Appears in Collections:Medical Sciences publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.