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Title: Hospital-acquired complications in intensive care unit patients with diabetes: A before-and-after study of a conventional versus liberal glucose control protocol.
Austin Authors: Luethi, Nora;Cioccari, Luca;Eastwood, Glenn M ;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
Affiliation: Intensive Care
Medicine (University of Melbourne)
Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland
Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Issue Date: Jul-2019
Date: 2019-03-18
Publication information: Acta Anaesthesiologica Scandinavica 2019; 63(6): 761-768
Abstract: 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. 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. 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. 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.
DOI: 10.1111/aas.13354
ORCID: 0000-0002-1650-8939
Journal: Acta Anaesthesiologica Scandinavica
PubMed URL: 30882892
Type: Journal Article
Subjects: Classification of Hospital Acquired Diagnoses (CHADx)
Intensive care
glucose control
glycated haemoglobin A1c
in-hospital complications
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