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Tight glycemic control produced fewer infections in infants
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QUEBEC CITY — A new post-hoc analysis of data published in The New England Journal of Medicine demonstrated that tight glycemic control after pediatric surgery produced fewer hospital-acquired infections in infants aged at least 60 days.
The post-hoc study involved 980 children and concluded that tight glycemic control after cardiac surgery in children aged 0 to 36 months does not significantly modify infection rate, mortality, length of stay or measures of organ failure vs. standard care.
The hypothesis was that tight glycemic control with insulin would decrease morbidity; in particular, infections acquired in the ICU.
“[The finding] poses some very interesting questions, and they should be able to be answered by having other researchers query their databases,” Michael S.D. Agus, MD, director of the medicine critical care program at Boston Children’s Hospital and associate professor at Harvard Medical School, told Endocrine Today. “We need to see whether in other previously collected datasets there is a differential response to therapy among those below 60 days of age compared with those above 60 days, similar to what we have found.”
When presenting the new data, Agus said he was careful to not be prescriptive about the results.
“This post-hoc analysis is suggestive,” he said in the interview. “If it is confirmed in other datasets and via meta-analyses, then it may be actionable. Based on the published data, one would have to say there is no benefit (of tight glycemic control) until proven otherwise.
“Treating with insulin in the pediatric ICU should only be done in a setting of a clinical trial at this point, with defined endpoints and with very clear protective strategies in place to reduce the incidence of hypoglycemia,” he said.
The other take-home message from the study is that tight glycemic control can be attained with minimal risk for severe hypoglycemia: only 3% of patients assigned to tight glycemic control in the study had severe hypoglycemia.
“We had the lowest hypoglycemia rate of any prospective trial that has ever been done in children or adults,” Agus said. “If you choose to do [tight glycemic control], in whatever setting, we now know that one can keep the hypoglycemia rate extremely low.”
For more information:
Agus MSD. Tight glucose control in pediatric critical care: Where do we stand? Presented at: Canadian Pediatric Endocrine Group 2013 Scientific Meeting; Jan. 24-26, 2013; Quebec City.
Agus MSD. N Engl J Med. 2012;367:1208-1219.
Disclosure: Agus is a consultant for Medtronic Inc. and Roche Diagnostics.