Decreased Mortality with Tight Glycemic Control in Critically Ill Patients: A Retrospective Analysis in a Large Community Hospital System |
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| Institution: | 1. Emory University School of Medicine, Atlanta, Georgia;;2. Main Line Health System and University of Pennsylvania, Philadelphia, Pennsylvania.;1. Department of Endocrinology, Albany Medical Center, Albany, New York;2. Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.;3. Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.;4. Departments of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.;1. Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, Illinois,;2. Section of Endocrinology, Rush University, Chicago, Illinois,;3. Division of Endocrinology, Loyola University, Maywood, Illinois;4. Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois.;1. Division of Endocrinology and Metabolism, Hofstra North Shore-LIJ School of Medicine, Long, Island, Jewish Medical Center, New Hyde Park, New York;;2. Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;;3. Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;;4. Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.;1. Saint Vincent Charity Medical Center, Cleveland, Ohio;2. D.Y. Rowland Associates, Cleveland Heights, Ohio;3. Case Western Reserve University, Cleveland, Ohio. |
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| Abstract: | ObjectiveTo measure the efficacy and possible adverse consequences of tight blood glucose (BG) control when compared to relaxed control.MethodsA retrospective, observational study was conducted at a community-based teaching hospital system among adult, nonmaternity hospitalized patients admitted to the intensive care unit (ICU). Tight glycemic control of BG was compared with less strict BG control, and the following outcome measurements were compared: BG, average length of stay (ALOS), severe hypoglycemia, and mortality.ResultsBetween 2008 and 2012, 18,919 patients were admitted to the ICU. The mortality rate was significantly lower (P = .0001) in patients with an average BG between 80 and 110 mg/dL (8%) and 111 and 140 mg/dL (9.4%) than in patients with average BG between 141 and 180 mg/dL (12.9%). Using tight glycemic control (80 to 110 mg/dL), the ALOS in the ICU decreased from 4 to 2.9 days (P < .0001) among all patients, and from 4.2 to 2.1 days (P < .0001) among patients who had undergone coronary artery bypass graft. Comparatively, the ALOS for the hospital decreased from 9.4 to 8 days. The incidence of severe hypoglycemia (BG < 40 mg/dL) was higher (P = .01) in the tight BG control group (4.78%) compared with the relaxed control group (3.5%). This rate was lower than in previously published studies that analyzed the use of tight control.ConclusionTight glycemic control using protocolbased insulin administration resulted in a decrease in mortality and ALOS among all patients in the ICU. The incidence of severe hypoglycemic episodes was slightly higher in the tightly controlled group but remained lower than in previously published studies. (Endocr Pract. 2014;20: 907-918) |
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