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Blood glucose targets effective for reducing mortality
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Personalized blood glucose targets for hospital patients based on preadmission HbA1c measures and diabetes status may be effective in reducing mortality rates, study data show.
“Glucose control in the critically ill has been a topic of major interest for the last 15 years,” James S. Krinsley, MD, FCCM, of the division of critical care, department of medicine, Stamford Hospital and Columbia University College of Physicians and Surgeons, told Endocrine Today. “The inconsistent results of the major interventional trials of intensive insulin therapy are likely due to several factors, including, in part, inadequate control, manifested by low time in targeted blood glucose range and high rates of hypoglycemia, as well as the choice of the blood glucose target.”
Krinsley and colleagues evaluated data on 1,979 patients admitted to a single ICU between Sept. 16, 2013, and Sept. 15, 2015. During the first year of the study, the blood glucose target was 90 mg/dL to 120 mg/dL for all participants, and HbA1c values were not routinely obtained. During the second year, the blood glucose target was 80 mg/dL to 140 mg/dL for participants without diabetes, and participants with diabetes treated with the tight protocol needed an HbA1c of less than 7% or a blood glucose target of 110 mg/dL to 160 mg/dL with HbA1c at least 7% for treatment with the loose protocol.
The second-year blood glucose target was associated with lower HbA1c, slightly lower mean blood glucose levels, lower maximum blood glucose levels and lower minimum blood glucose levels among participants without diabetes. Participants with diabetes treated during the second year with the loose target had higher mean blood glucose levels, higher maximum blood glucose levels, greater glucose variability and less hypoglycemia compared with participants with diabetes treated with the loose protocol.
Overall, mortality was 12.1% in the first year and 11.3% in the second year for all participants. Among participants without diabetes, mortality was similar between the two periods. However, during the second year, there was a reduction in mortality from 13.3% to 11% among participants with diabetes (P = .57). There was also a reduction in mortality from 14.2% to 9.9% among participants with diabetes and HbA1c at least 7% (P = .53).
“A substantial body of observational literature suggests that the relationship between glucose metrics and mortality is different for patients with and without diabetes,” Krinsley told Endocrine Today. “Moreover, for patients with diabetes, preadmission glycemia (reflected by HbA1c levels) is an important modulating factor. Several studies suggest that patients with high HbA1c levels should have higher blood glucose targets while being treated in the ICU. In contrast, well-controlled patients with diabetes (eg, with low HbA1c levels) have lower mortality rates when treated with tighter targets.” – by Amber Cox
For more information:
James S. Krinsley, MD, FCCM, can be reached at james.krinsley@gmail.com.
Disclosure: Krinsley reports being on the consulting/advisory board for Edwards Lifesciences, Medtronic, OptiScan Biomedical and Roche Diagnostics. Please see the full study for a list of all other authors’ relevant financial disclosures.
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