Percent of time in range 70-139mg/dL is associated with reduced mortality among critically ill patients receiving intravenous insulin infusion.
Chest. 2019 Jun 12;:
Authors: Lanspa MJ, Krinsley JS, Hersh AM, Wilson EL, Holmen JR, Orme JF, Morris AH, Hirshberg EL
INTRODUCTION: In addition to hyperglycemia, hypoglycemia, and glycemic variability, reduced time in targeted blood glucose range (TIR) is associated with increased risk of death in critically ill patients. This relationship between TIR and mortality may be confounded by diabetic status and antecedent glycemic control.
METHODS: We retrospectively analyzed critically ill patients managed with the same intravenous insulin protocol at multiple centers. We calculated the percent of TIR between 70-139 mg/dl. We excluded patients with diabetic ketoacidosis, patients who had fewer than 10 blood glucose readings, and repeat admissions. We used the highest recorded glycosylated hemoglobin in the preceding 3 months or up to one month after admission as a surrogate for the patient's pre-existing glucose control. We performed stratified regression analyses for 30-day mortality, with covariates of age, sex, TIR > 80%, Acute Physiology Score, and Charlson comorbidity index.
RESULTS: We studied 9028 patients, 53.2% of whom had diabetes. Median TIR was 84.1% for non-diabetic patients and 64.5% for diabetic patients. Mortality was lower in those with TIR > 80% compared to those with TIR < 80% (12.4% vs 19.2%, p<0.001). TIR > 80% was independently associated with reduced mortality in non-diabetic (OR 0.53, p < 0.001), diabetic (OR 0.69, p = 0.001), and well-controlled patients (OR 0.50, p < 0.001), but not in poorly controlled patients (OR 0.86, p = 0.40).
CONCLUSIONS: TIR is independently associated with mortality in critically ill patients, particularly those with good antecedent glucose control.
PMID: 31201784 [PubMed - as supplied by publisher]