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, Luca Cioccari, Glenn Eastwood, Peter Biesenbach, Rhys Morgan, Stephanie Sprogis, Helen Young, Leah Peck, Christine Knee Chong, Sandra Moore, Kylie Moon, Elif I. Ekinci, Adam M. Deane, Rinaldo Bellomo, Johan Mårtensson

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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.

Original languageEnglish
Pages (from-to)761-768
Number of pages8
JournalActa Anaesthesiologica Scandinavica
Volume63
Issue number6
DOIs
Publication statusPublished - Jul 2019

Keywords

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

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