Tight Glycemic Control and Improved Mortality in ICU Patients

According to the findings of a recent retrospective study, tight glycemic control in intensive care unit (ICU) patients is associated with lower mortality and decreased length of stay, when compared with less rigid glycemic control.

Renu Joshi, MD, of Pinnacle Health System in Mechanicsburg, PA, and colleagues presented their findings at ENDO 2013: The Endocrine Society’s 95^th Annual Meeting & Expo in San Francisco on June 18, 2013.

According to the authors, there has been controversy surrounding the issue of glycemic control in critically ill patients and its effect on mortality and length of stay. The current recommendation, according to the American College of Endocrinology, is for maintenance of blood sugar (BS) at 140-180mg/dl for patients admitted to critical care units, which is more relaxed than previous guidelines. This study is a retrospective evaluation of glycemic control and effect on mortality, length of ICU stay, and incidence of hypoglycemia.

More than 12,000 patients admitted to medical and surgical ICUs from two acute care facilities from 2008 to 2012 were included. They were then classified into separate groups based on their average BS: Group 1: 80-110mg/dl, Group 2: 110-140mg/dl, and Group 3: 140-180mg/dl. Most of the surgical patients (22% of the total subjects) fell into Groups 1 and 2. The primary outcome was ICU mortality. Secondary outcomes included hospital length of stay, ICU length of stay, and incidence of severe hypoglycemia (BS < 40mg/dl). Logistic regression analysis was performed.

Lower ICU mortality rates were seen in Group 1 (8.34%) and Group 2 (9.61%) as compared with Group 3 (12.94%). This was statistically significant (p < 0.005). The ICU stay was significantly shorter in Group 1 (2.91 days, p < 0.05) than in Group 2 (4.48) and Group 3 (4.04). There was no significant difference between Groups 2 and 3. The rate of severe hypoglycemia was higher in Group 1 (4.77%) when compared with Group 2 (3.36%) and Group 3 (3.47%). The rate of hypoglycemia in postsurgical subjects was the lowest (2.86%).

The authors concluded that tight glycemic control (80-100mg/dl in this case) is beneficial for ICU mortality rate and length of stay, and they acknowledge that these parameters differ from current guidelines. The rate of hypoglycemia increased with tighter control. The authors note that the rate of hypoglycemia in Group 1 reported here is lower than what has been previously published. The authors do not currently have data regarding HbA1c levels or nutritional data; their studies are ongoing.

The authors have nothing to disclose.