Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis

Johan Mårtensson, Michael Bailey, Balasubramanian Venkatesh, David Pilcher, Adam Deane, Yasmine Ali Abdelhamid, Marco Crisman, Brij Verma, Christopher MacIsaac, Geoffrey Wigmore, Yahya Shehabi, Takafumi Suzuki, Craig French, Neil Orford, Nima Kakho, Johannes Prins, Elif I. Ekinci, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)266-273
Number of pages8
JournalCritical Care and Resuscitation
Volume19
Issue number3
Publication statusPublished - 1 Sep 2017

Cite this

Mårtensson, Johan ; Bailey, Michael ; Venkatesh, Balasubramanian ; Pilcher, David ; Deane, Adam ; Abdelhamid, Yasmine Ali ; Crisman, Marco ; Verma, Brij ; MacIsaac, Christopher ; Wigmore, Geoffrey ; Shehabi, Yahya ; Suzuki, Takafumi ; French, Craig ; Orford, Neil ; Kakho, Nima ; Prins, Johannes ; Ekinci, Elif I. ; Bellomo, Rinaldo. / Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis. In: Critical Care and Resuscitation. 2017 ; Vol. 19, No. 3. pp. 266-273.
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title = "Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis",
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.",
author = "Johan M{\aa}rtensson and Michael Bailey and Balasubramanian Venkatesh and David Pilcher and Adam Deane and Abdelhamid, {Yasmine Ali} and Marco Crisman and Brij Verma and Christopher MacIsaac and Geoffrey Wigmore and Yahya Shehabi and Takafumi Suzuki and Craig French and Neil Orford and Nima Kakho and Johannes Prins and Ekinci, {Elif I.} and Rinaldo Bellomo",
year = "2017",
month = "9",
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language = "English",
volume = "19",
pages = "266--273",
journal = "Critical Care and Resuscitation",
issn = "1441-2772",
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number = "3",

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Mårtensson, J, 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, EI & Bellomo, R 2017, 'Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis', Critical Care and Resuscitation, vol. 19, no. 3, pp. 266-273.

Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis. / Mårtensson, Johan; Bailey, Michael; Venkatesh, Balasubramanian; Pilcher, David; Deane, Adam; Abdelhamid, Yasmine Ali; Crisman, Marco; Verma, Brij; MacIsaac, Christopher; Wigmore, Geoffrey; Shehabi, Yahya; Suzuki, Takafumi; French, Craig; Orford, Neil; Kakho, Nima; Prins, Johannes; Ekinci, Elif I.; Bellomo, Rinaldo.

In: Critical Care and Resuscitation, Vol. 19, No. 3, 01.09.2017, p. 266-273.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis

AU - Mårtensson, Johan

AU - Bailey, Michael

AU - Venkatesh, Balasubramanian

AU - Pilcher, David

AU - Deane, Adam

AU - Abdelhamid, Yasmine Ali

AU - Crisman, Marco

AU - Verma, Brij

AU - MacIsaac, Christopher

AU - Wigmore, Geoffrey

AU - Shehabi, Yahya

AU - Suzuki, Takafumi

AU - French, Craig

AU - Orford, Neil

AU - Kakho, Nima

AU - Prins, Johannes

AU - Ekinci, Elif I.

AU - Bellomo, Rinaldo

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

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