Hospital-acquired complications in intensive care unit patients with diabetes: A before-and-after study of a conventional versus liberal glucose control protocol.

Luethi, Nora; Cioccari, Luca; Eastwood, Glenn; Biesenbach, Peter; Morgan, Rhys; Sprogis, Stephanie; Young, Helen; Peck, Leah; Knee Chong, Christine; Moore, Sandra; Moon, Kylie; Ekinci, Elif I; Deane, Adam M; Bellomo, Rinaldo; Mårtensson, Johan (2019). Hospital-acquired complications in intensive care unit patients with diabetes: A before-and-after study of a conventional versus liberal glucose control protocol. Acta anaesthesiologica Scandinavica, 63(6), pp. 761-768. Wiley-Blackwell 10.1111/aas.13354

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BACKGROUND Critically ill patients with diabetes mellitus (DM) are at increased risk of in-hospital complications and the optimal glycemic target for such patients remains unclear. A more liberal approach to glucose control has recently been suggested for patients with DM, but uncertainty remains regarding its impact on complications. METHODS We aimed to test the hypothesis that complications would be more common with a liberal glycemic target in ICU patients with DM. Thus, we compared hospital-acquired complications in the first 400 critically ill patients with DM included in a sequential before-and-after trial of liberal (glucose target: 10-14 mmol/L) vs conventional (glucose target: 6-10 mmol/L) glucose control. RESULTS Of the 400 patients studied, 165 (82.5%) patients in the liberal and 177 (88.5%) in the conventional-control group were coded for at least one hospital-acquired complication (P = 0.09). When comparing clinically relevant complications diagnosed between ICU admission and hospital discharge, we found no difference in the odds for infectious (adjusted odds ratio [aOR] for liberal-control: 1.15 [95% CI: 0.68-1.96], P = 0.60), cardiovascular (aOR 1.40 [95% CI: 0.63-3.12], P = 0.41) or neurological complications (aOR: 1.07 [95% CI: 0.61-1.86], P = 0.81), acute kidney injury (aOR 0.83 [95% CI: 0.43-1.58], P = 0.56) or hospital mortality (aOR: 1.09 [95% CI: 0.59-2.02], P = 0.77) between the liberal and the conventional-control group. CONCLUSION In this prospective before-and-after study, liberal glucose control was not associated with an increased risk of hospital-acquired infectious, cardiovascular, renal or neurological complications in critically ill patients with diabetes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Cioccari, Luca

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0001-5172

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

31 May 2019 13:06

Last Modified:

23 Oct 2019 08:13

Publisher DOI:

10.1111/aas.13354

PubMed ID:

30882892

Uncontrolled Keywords:

Classification of Hospital Acquired Diagnoses (CHADx) Intensive care diabetes glucose control glycated haemoglobin A1c hypoglycaemia in-hospital complications insulin

BORIS DOI:

10.7892/boris.129316

URI:

https://boris.unibe.ch/id/eprint/129316

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