- Poster presentation
- Open Access
Personalised glucose therapy: glucose targets in critically ill patients with pre-existing poorly controlled type 2 diabetes
© Kar et al.; 2015
- Published: 1 October 2015
- Intensive Care Unit
- Glucose Concentration
- Charlson Comorbidity Index
- Blood Glucose Concentration
- Intensive Care Unit Mortality
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 . Accordingly a higher glucose target may benefit these patients.
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.
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.
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.
Dr Kar is supported by a Royal Adelaide Hospital A.R. Clarkson Scholarship
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.