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

Luethi, N, Cioccari, L, Eastwood, G, Biesenbach, P, Morgan, R, Sprogis, Stephanie, Young, H, Peck, L, Knee Chong, C, Moore, S, Moon, K, Ekinci, EI, Deane, AM, Bellomo, R and Mårtensson, J 2019, Hospital-acquired complications in intensive care unit patients with diabetes: a before-and-after study of a conventional versus liberal glucose control protocol, Acta anaesthesiologica Scandinavica, vol. 63, no. 6, pp. 761-768, doi: 10.1111/aas.13354.

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Title Hospital-acquired complications in intensive care unit patients with diabetes: a before-and-after study of a conventional versus liberal glucose control protocol
Author(s) Luethi, N
Cioccari, L
Eastwood, G
Biesenbach, P
Morgan, R
Sprogis, StephanieORCID iD for Sprogis, Stephanie orcid.org/0000-0003-4259-6976
Young, H
Peck, L
Knee Chong, C
Moore, S
Moon, K
Ekinci, EI
Deane, AM
Bellomo, R
Mårtensson, J
Journal name Acta anaesthesiologica Scandinavica
Volume number 63
Issue number 6
Start page 761
End page 768
Total pages 8
Publisher Wiley
Place of publication Chichester, Eng.
Publication date 2019-07
ISSN 0001-5172
1399-6576
Keyword(s) Classification of Hospital Acquired Diagnoses (CHADx)
Intensive care
diabetes
glucose control
glycated haemoglobin A1c
hypoglycaemia
in-hospital complications
insulin
Summary 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.
Language eng
DOI 10.1111/aas.13354
Indigenous content off
Field of Research 1103 Clinical Sciences
1109 Neurosciences
1116 Medical Physiology
HERDC Research category C1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30149686

Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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