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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

Personalised glucose therapy: glucose targets in critically ill patients with pre-existing poorly controlled type 2 diabetes

  • 1, 2,
  • 1, 2,
  • 3,
  • 4,
  • 4,
  • 5, 6,
  • 1, 2, 6,
  • 5, 6 and
  • 1, 2, 6
Intensive Care Medicine Experimental20153 (Suppl 1) :A290

https://doi.org/10.1186/2197-425X-3-S1-A290

  • Published:

Keywords

  • Intensive Care Unit
  • Glucose Concentration
  • Charlson Comorbidity Index
  • Blood Glucose Concentration
  • Intensive Care Unit Mortality

Introduction

In patients without pre-existing diabetes, hyperglycaemia during critical illness is associated with adverse outcomes. However, recent observational data suggest that in patients with pre-existing poorly controlled type 2 diabetes (defined as an HbA1c ≥7%) prior to their acute illness, targeting glucose concentrations < 10mmol/l is associated with harm [1]. Accordingly a higher glucose target may benefit these patients.

Objectives

To determine whether more liberal glucose targets in critically ill patients with pre-existing poorly controlled type 2 diabetes increases time weighted mean glucose concentration, attenuates hypoglycaemia, and appears overtly safe.

Methods

Prospective, open-label, sequential period, pilot study of 86 patients with poorly controlled type 2 diabetes (admission HbA1c ≥ 7.0%) and a blood glucose concentration > 10mmol/L requiring admission to the Intensive Care Unit (ICU) and administration of insulin. The 'control' patients (n = 53) were consecutively admitted during a 6 month period and the 'intervention' patients (n = 33) were admitted during a subsequent 6 month period. During the 'control' period blood glucose was targeted between 6-10mmol/l, whereas during the 'intervention' period the target was 10-14mmol/l. Time weighted mean glucose was calculated and recorded blood glucose concentrations < 4.0mmol/l considered as an hypoglycaemic episode for each patient. Data are mean (SE) or median [IQR] and analysed using independent samples t-test, Mann-Whitney test, Chi-squared test, Linear and Logistic regression as appropriate.

Results

The groups were well matched in terms of age (Control: 64.0 (2.0) vs Intervention: 62.6 (2.0) years), admission HbA1c (8.5 (0.2) vs 8.8 (0.2)%), APACHE II score (20.4 (1.0) vs 20.5 (1.2)) and Charlson Comorbidity Index (4.5 (0.3) vs 4.3 (0.3)). More liberal targets resulted in greater time weighted mean glucose concentrations (TWGlucoseday0-7 9.3 (0.3) vs 10.2 (0.4) mmol/l, P = 0.04) and there was a trend towards fewer patients with hypoglycaemic episodes (34% vs 16% of patients, P = 0.07). There was no difference in ICU mortality (10 [19%] vs 6 [18%], P = 0.94) or 90-day mortality (19 [36%] vs 12 [36%], P = 0.96). ICU length of stay was shorter in the 'control' period (3.5 [4.0] vs 6.3 [8.7] days, P = 0.01) with significance persisting when adjusting for APACHE scores and Charlson Comorbidity Index (P = 0.04).
Figure 1
Figure 1

Mean time weighted glucose between groups.

Conclusions

In critically ill patients with pre-existing poorly controlled type 2 diabetes, more liberal glucose targets increase mean glucose concentrations may reduce the incidence of insulin- induced hypoglycaemia, and appear to be overtly safe. Prospective studies using larger cohorts are indicated.

Grant Acknowledgment

Dr Kar is supported by a Royal Adelaide Hospital A.R. Clarkson Scholarship

Authors’ Affiliations

(1)
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
(2)
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
(3)
Intensive Care Unit, The Austin Hospital, Melbourne, Australia
(4)
NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
(5)
Discipline of Medicine, University of Adelaide, Adelaide, Australia
(6)
NHMRC Centre for Research Excellence, University of Adelaide, Adelaide, Australia

References

  1. Plummer MP, Bellomo R, Cousins CE, et al: Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive care Medicine. 2014, 24: 973-80.View ArticleGoogle Scholar

Copyright

© Kar et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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