New Information for Diabetics in Critical Care: Diabetics anticipate hearing physicians call for tight control over their blood glucose levels. That’s what makes a March 24th, 2009 article by the New England Journal of Medicine interesting with respect to their conclusion. This report suggests that in critically ill patients it may actually be counterproductive to effective recovery to insist on blood glucose control. The medical journal indicates mortality rates are higher among critically ill diabetics when hyperglycemia is treated using strict blood glucose oversight.
On the same day the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) issued a press release indicating, “Findings of the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study should NOT lead to an abandonment of the concept of good glucose management in the hospital setting. Uncontrolled high blood glucose can lead to serious problems for hospitalized patients, such as dehydration and increased propensity to infection.”
Dr. Etie S. Moghissi, AACE Chair of Inpatient Glycemic Control Task Force said, “Since 2003, AACE and the ADA have worked together to provide recommendations for treatment of inpatient hyperglycemia, and these efforts have contributed to a growing national movement viewing the management of hyperglycemia in hospitals as a quality care measure.”
Further recommendations from the ADA and AACE in regards to this issue will be made available later in the spring. Dr. Mary Korytkowski, ADA Chair of Inpatient Glycemic Control Task Force indicated, “The central goal of the ADA/AACE inpatient task force is to identify reasonable, achievable, and safe glucose targets, and to describe the protocols, procedures, and system improvements needed to achieve inpatient optimal glucose control efficiently and safely.”
The NICE-SUGAR study suggests that mortality rates in patients with intense glucose control while also in critical condition was 14% higher than those receiving standard or conventional glucose care.
The ADA or AACE press release stated, “More than 6,100 patients with hyperglycemia in critical care units were randomized to either intensive glucose control (insulin infusion with target blood glucose between 80-108 mg/dl) or to conventional glucose control (insulin infusion begun if blood glucose was over 180 mg/dl, and discontinued if blood glucose dropped below 144 mg/dl). Severe hypoglycemia (blood glucose below 40 mg/dl) occurred in approximately 6.8 percent of intensively treated patients compared to 0.5 percent of conventionally treated patients. The study showed no difference in length of time in the intensive care unit or in the hospital, or in other major outcomes such as time on ventilators or need for dialysis.”
It seems clear from the information provided by these two health organizations that they are asking for caution in the wake of these new findings.
For those unfamiliar with the American Association of Clinical Endocrinologists (AACE) it is a, “Professional medical organization with more than 6,200 members in the United States and 92 other countries.