Moderate glucose control is associated with increased mortality compared to tight glucose control in critically ill non-diabetics.
Chest. 2012 Nov 29;
Authors: Lanspa MJ, Hirshberg EL, Phillips GD, Holmen J, Stoddard G, Orme J
INTRODUCTION: Optimal glucose management in the ICU remains unclear. In 2009, many clinicians at Intermountain Healthcare selected a moderate glucose control (90-140mg/dL) instead of tight glucose control (80-110mg/dL). We hypothesized that moderate glucose control would affect patients with and without pre-existing diabetes differently. METHODS: We performed a retrospective cohort analysis of all patients treated with eProtocol-insulin from November 2006 to March 2011, stratifying for diabetes. We performed multivariate logistic regression for 30-day mortality with covariates of age, modified APACHE II score, Charlson Comorbidity score, and target glucose. RESULTS: We studied 3529 patients in 12 different ICUs in 8 different hospitals. Diabetic patients had higher mean glucose (132 vs. 124mg/dL) and greater glycemic variability (sd = 41 vs. 29 mg/dL) than did non-diabetics (p <0.01 for both comparisons). Tight glucose control was associated with increased frequency of moderate and severe hypoglycemia (30.3% and 3.6%) compared to moderate glucose control (14.3% and 2.0%; p <0.01 for both). Multivariate analysis demonstrated that the moderate glucose target was independently associated with increased risk of mortality in non-diabetics (OR 1.36, 95% CI 1.01-1.84, p = 0.05), but decreased risk of mortality in diabetics (OR 0.65, 0.45-0.93, p = 0.01). CONCLUSIONS: Moderate glucose control (90-140mg/dL) may confer greater mortality in non-diabetic, critically ill patients compared to tight glucose control (80-110mg/dL). A single glucose target does not appear optimal for all critically ill patients. These data have important implications for the design of future interventional trials as well as for the glycemic management of critically ill patients.
PMID: 23238456 [PubMed - as supplied by publisher]