Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study

Kaukonen, Kirsi-Maija, Bailey, Michael, Pilcher, David, Orford, Neil, Finfer, Simon and Bellomo, Rinaldo 2013, Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study, Critical care, vol. 17, no. 5, doi: 10.1186/cc13030.

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Title Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
Author(s) Kaukonen, Kirsi-Maija
Bailey, Michael
Pilcher, David
Orford, NeilORCID iD for Orford, Neil orcid.org/0000-0002-2285-9233
Finfer, Simon
Bellomo, Rinaldo
Journal name Critical care
Volume number 17
Issue number 5
Article ID R215
Total pages 10
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2013-10-02
ISSN 1466-609X
Keyword(s) APACHE
Adult
Aged
Algorithms
Australia
Blood Glucose
Critical Care
Critical Illness
Diabetes Mellitus
Female
Humans
Hypoglycemic Agents
Insulin
Male
Middle Aged
New Zealand
Retrospective Studies
Survival Rate
Translational Medical Research
Treatment Outcome
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
CRITICALLY-ILL PATIENTS
CONVENTIONAL GLUCOSE CONTROL
INTENSIVE INSULIN THERAPY
BLOOD-GLUCOSE
MORTALITY
HYPERGLYCEMIA
CARE
MANAGEMENT
GUIDELINES
ADMISSION
Summary INTRODUCTION: There is no information on the uptake of Intensive Insulin Therapy (IIT) before the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial in Australia and New Zealand (ANZ) and on the bi-national response to the trial, yet such data would provide important information on the evolution of ANZ practice in this field. We aimed to study ANZ glycaemic control before and after the publication of the results of the NICE-SUGAR trial. METHODS: We analysed glucose control in critically ill patients across Australia and New Zealand during a two-year period before and after the publication of the NICE-SUGAR study. We used the mean first day glucose (Glu1) (a validated surrogate of ICU glucose control) to define practice. The implementation of an IIT protocol was presumed if the median of Glu₁ measurements was <6.44 mmol/L for a given ICU. Hypoglycaemia was categorised as severe (glucose ≤2.2 mmol/L) or moderate (glucose ≤3.9 mmol/L). RESULTS: We studied 49 ICUs and 176,505 patients. No ICU practiced IIT before or after NICE-SUGAR. Overall, Glu1 increased from 7.96 (2.95) mmol/L to 8.03 (2.92) mmol/L (P <0.0001) after NICE-SUGAR. Similar increases were noted in all patient subgroups studied (surgical, medical, insulin dependent diabetes mellitus, ICU stay >48/<48 hours). The rate of severe and moderate hypoglycaemia before and after NICE-SUGAR study were 0.59% vs. 0.55% (P =0.33) and 6.62% vs. 5.68% (P <0.0001), respectively. Both crude and adjusted mortalities declined over the study period. CONCLUSIONS: IIT had not been adopted in ANZ before the NICE-SUGAR study and glycaemic control corresponded to that delivered in the control arm of NICE-SUGAR trial. There were only minor changes in practice after the trial toward looser glycaemic control. The rate of moderate hypoglycaemia and mortality decreased along with such changes.
Language eng
DOI 10.1186/cc13030
Field of Research 11 Medical And Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, Kaukonen et al.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30115556

Document type: Journal Article
Collections: School of Medicine
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