scholarly journals Reducing Glycemic Variability in Intensive Care Unit Patients: A New Therapeutic Target?

2009 ◽  
Vol 3 (6) ◽  
pp. 1302-1308 ◽  
Author(s):  
Moritoki Egi ◽  
Rinaldo Bellomo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Intensive Insulin Therapy ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Glucose Levels ◽  
Lower Glucose

Acute hyperglycemia is common in critically ill patients. Strict control of blood glucose (BG) concentration has been considered important because hyperglycemia is associated independently with increased intensive care unit mortality. After intensive insulin therapy was reported to reduce mortality in selected surgical critically ill patients, lowering of BG levels was recommended as a means of improving patient outcomes. However, a large multicenter multination study has found that intensive insulin therapy increased mortality significantly. A difference in variability of BG control may be one possible explanation why the effect of intensive insulin therapy varied from beneficial to harmful. Several studies have confirmed significant associations between variability of BG levels and patient outcomes. Decreasing the variability of the BG concentration may be an important dimension of glucose management. If reducing swings in the BG concentration is a major biologic mechanism behind the putative benefits of glucose control, it may not be necessary to pursue lower glucose levels with their attendant risk of hypoglycemia.

Thiamine Levels During Intensive Insulin Therapy in Critically Ill Patients

2016 ◽  
Vol 32 (9) ◽  
pp. 559-564 ◽  
Author(s):  
Wouter van Snippenburg ◽  
Mariet G. J. Reijnders ◽  
Jose G. M. Hofhuis ◽  
Rien de Vos ◽  
Stephan Kamphuis ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Critically Ill Patients ◽  
Thiamine Deficiency ◽  
Gastrointestinal Disease ◽  
Glucose Levels ◽  
Gastrointestinal Pathology ◽  
Observational Prospective Cohort Study ◽  
Thiamine Level

Introduction: Thiamine is an essential cofactor in carbohydrate metabolism, and deficiency can therefore cause various organ dysfunctions. Little is known about the prevalence and possible worsening of thiamine deficiency in critically ill patients. In this study, we investigated the prevalence of thiamine deficiency at admission to the intensive care unit (ICU) and hypothesized that intensive insulin therapy, aimed at regulating glucose levels, increases thiamine utilization and therefore might cause or worsen deficiency in patients with limited thiamine stores. Materials and Methods: An observational prospective cohort study was carried out in a medical–surgical ICU in a general teaching hospital in Apeldoorn, the Netherlands. All adults who were treated during that time with intensive insulin therapy were included. Deficiency was defined as a thiamine level <100 nmol/L. No thiamine supplementation was administered except for normal amounts present in standard enteral feeding. Results: A total of 58 patients were available for analysis. Median thiamine level at admission was 111 nmol/L. Deficiency was present in 39.7% of patients and was significantly associated with the presence of gastrointestinal pathology and with recent surgery. Thiamine levels increased a median of 14 nmol/L in 48 hours. Only 3.4% of patients showed a predefined relevant decline in thiamine levels. Conclusion: Intensive insulin therapy does not appear to cause or worsen thiamine deficiency. However, based on the high prevalence of deficiency at admission, it might be warranted to supplement thiamine in all patients admitted to the ICU, especially when there is an underlying gastrointestinal disease or recent surgery.

scholarly journals Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Priscila Bellaver ◽  
Ariell F. Schaeffer ◽  
Diego P. Dullius ◽  
Marina V. Viana ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Stress Hyperglycemia ◽  
Critically Ill Adults ◽  
Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

scholarly journals Insulin therapy for hyperglycemia in critically ill patients

2016 ◽  
Vol 53 (5) ◽  
pp. 250
Author(s):  
Julianti Julianti ◽  
Silvia Triratna ◽  
Aditiawati Aditiawati ◽  
Irfanuddin Irfanuddin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Mortality Rate ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Therapy Group ◽  
Control Group

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores ≤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

Effects of Different Blood Glucose Levels on Critically Ill Patients in an Intensive Care Unit

2015 ◽  
Vol 25 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Li Kang ◽  
Juan Han ◽  
Qun-Cao Yang ◽  
Hui-Lin Huang ◽  
Nan Hao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fasting Blood Glucose ◽  
Apache Ii Score ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

<b><i>Aims:</i></b> We explore the infection incidence and possible prognostic outcome relevance for patients with different blood glucose levels in an intensive care unit (ICU). <b><i>Methods:</i></b> A total of 98 cases were enrolled and divided into three groups based on average fasting blood glucose levels (group A: ≤6.1 mmol/l; group B: 6.1-10 mmol/l; group C: ≥10 mmol/l). <b><i>Results:</i></b> There were no statistical differences in the time to ICU admission, the indwelling durations of gastric tubes, urinary or deep vein catheters, tracheal intubations and tracheotomies, or the length of ventilator use (all p > 0.05). No evident difference in the multiple organ dysfunction syndrome rate was found between the three groups (p = 0.226). The infection and mortality rates between the groups showed significant differences (all p < 0.05). Furthermore, the difference of respiratory system infections was statistically significant among the three groups (p = 0.008), yet no such statistical difference was observed among groups regarding nonrespiratory system infections (p = 0.227). <b><i>Conclusions:</i></b> Critically ill patients with a high blood glucose level were positively correlated with a relatively high APACHE II score and more serious degree of disease, as well as a higher incidence of respiratory infection during their ICU stay than those with lower blood glucose levels (<10 mmol/l).

Variability of Blood Glucose Concentration and Short-term Mortality in Critically Ill Patients

2006 ◽  
Vol 105 (2) ◽  
pp. 244-252 ◽  
Author(s):  
Moritoki Egi ◽  
Rinaldo Bellomo ◽  
Edward Stachowski ◽  
Craig J. French ◽  
Graeme Hart
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Hospital Mortality ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Critically Ill Patients ◽  
Glucose Concentration ◽  
Intensive Care Unit Mortality ◽  
Blood Glucose Concentration

Background Intensive insulin therapy may reduce mortality and morbidity in selected surgical patients. Intensive insulin therapy also reduced the SD of blood glucose concentration, an accepted measure of variability. There is no information on the possible significance of variability in glucose concentration. Methods The methods included extraction of blood glucose values from electronically stored biochemical databases and of data on patient's characteristics, clinical features, and outcome from electronically stored prospectively collected patient databases; calculation of SD of glucose as a marker of variability and of several indices of glucose control in each patient; and statistical assessment of the relation between these variables and intensive care unit mortality. Results There were 168,337 blood glucose measurements in the study cohort of 7,049 critically ill patients (4.2 hourly measurements on average). The mean +/- SD of blood glucose concentration was 1.7 +/- 1.3 mM in survivors and 2.3 +/- 1.6 mM in nonsurvivors (P &lt; 0.001). Using multiple variable logistic regression analysis, both mean and SD of blood glucose were significantly associated with intensive care unit mortality (P &lt; 0.001; odds ratios [per 1 mM] 1.23 and 1.27, respectively) and hospital mortality (P &lt; 0.001 and P = 0.013; odds ratios [per 1 mM] 1.21 and 1.18, respectively). Conclusions The SD of glucose concentration is a significant independent predictor of intensive care unit and hospital mortality. Decreasing the variability of blood glucose concentration might be an important aspect of glucose management.

scholarly journals Screening of Hyperglycemic Patients Admitted in Intensive Care Unit

2013 ◽  
Vol 5 (1) ◽  
pp. 63-69
Author(s):  
Santosh Kumar ◽  
Awadhesh Kumar Arya ◽  
Ritwiz Bihari ◽  
Deepa Pokharia ◽  
Hemant Kumar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Medical Science ◽  
Controlled Study ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
History Of

Background & objectives: It is a prospective, randomized, controlled study involving adults admitted to medical Intensive care unit (ICU) who were receiving mechanical ventilation. Methods: On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood sugar at a level between 80 and 110 mg/dl) and were found to have hyperglycemic. We study the clinical profile of critically ill hyperglycemic patients and associated metabolic profiles of all such patients were analyzed in relation to final outcome. Results: The benefit of intensive insulin care was from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). Intensive insulin therapy to maintain blood glucose at or below 110mg per deciliter reduced the morbidity and motility among critically ill patients in the surgical intensive care unit. Hyperglycemia was present in 38% of patient admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before admission. Interpretation & conclusions: New hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to an intermediate care unit. DOI: http://dx.doi.org/10.3126/ajms.v5i1.8507   Asian Journal of Medical Science Vol.5(1) 2014 pp.63-69

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