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Comparative Study
. 2019 Jul;63(6):761-768.
doi: 10.1111/aas.13354. Epub 2019 Mar 18.

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

Nora Luethi  1   2 , Luca Cioccari  1   2   3 , Glenn Eastwood  1   2 , Peter Biesenbach  1 , Rhys Morgan  1 , Stephanie Sprogis  1 , Helen Young  1 , Leah Peck  1 , Christine Knee Chong  1 , Sandra Moore  1 , Kylie Moon  1 , Elif I Ekinci  4   5 , Adam M Deane  6 , Rinaldo Bellomo  1   2   6 , Johan Mårtensson  1   7
Affiliations
Comparative Study

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

Nora Luethi et al. Acta Anaesthesiol Scand. 2019 Jul.

Abstract

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.

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

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