Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16882
Title: Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis
Austin Authors: Mårtensson, Johan;Bailey, M;Venkatesh, B;Pilcher, D;Deane, A;Abdelhamid, YA;Crisman, M;Verma, B;MacIsaac, C;Wigmore, G;Shehabi, Y;Suzuki, T;French, C;Orford, N;Kakho, N;Prins, J;Ekinci, Elif I ;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
Department of Intensive Care, Wesley and Princess Alexandra Hospitals, University of Queensland, Brisbane, Queensland, Australia
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
Department of Intensive Care, Frankston Hospital, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Clinical School of Medicine, Monash University, Program Critical Care, Monash Health, Melbourne, Victoria, Australia
Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
Department of Intensive Care, Geelong Hospital, Geelong, Victoria, Australia
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Sep-2017
metadata.dc.date: 2017-09
Publication information: Critical Care and Resuscitation 2017; 19(3): 266-273
Abstract: OBJECTIVES: To determine the impact of the intensity of early correction of hyperglycaemia on outcomes in patients with diabetic ketoacidosis (DKA) admitted to the intensive care unit. METHODS: We studied adult patients with DKA admitted to 171 ICUs in Australia and New Zealand from 2000 to 2013. We used their blood glucose levels (BGLs) in the first 24 hours after ICU admission to determine whether intensive early correction of hyperglycemia to ≤ 180 mg/dL was independently associated with hypoglycaemia, hypokalaemia, hypo-osmolarity or mortality, compared with partial early correction to > 180 mg/dL as recommended by DKA-specific guidelines. RESULTS: Among 8553 patients, intensive early correction of BGL was applied to 605 patients (7.1%). A greater proportion of these patients experienced hypoglycaemia (20.2% v 9.1%; P < 0.001) and/or hypo-osmolarity (29.4% v 22.0%; P < 0.001), but not hypokalaemia (16.7% v 15.6%; P = 0.47). Overall, 11 patients (1.8%) in the intensive correction group and 112 patients (1.4%) in the partial correction group died (P = 0.42). However, after adjustment for illness severity, partial early correction of BGL was independently associated with a lower risk of hypoglycaemia (odds ratio [OR], 0.38; 95% CI, 0.30-0.48; P < 0.001), lower risk of hypo-osmolarity (OR, 0.80; 95% CI, 0.65-0.98; P < 0.03) and lower risk of death (OR, 0.44; 95% CI, 0.22-0.86; P = 0.02). CONCLUSIONS: In a large cohort of patients with DKA, partial early correction of BGL according to DKA-specific guidelines, when compared with intensive early correction of BGL, was independently associated with a lower risk of hypoglycaemia, hypo-osmolarity and death.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16882
ORCID: 0000-0002-1650-8939
0000-0003-2372-395X
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/28866977
Type: Journal Article
Appears in Collections:Journal articles

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