To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Tight Glucose Control in Critically Ill Patients Does Not Reduce Risk of Death in Hospital URL: http://www.pslgroup.com/dg/22A0B6.htm Doctor's Guide August 27, 2008
CHICAGO -- August 27, 2008 -- An analysis of randomised trials indicates that for critically ill adults, tight glucose control is not associated with a significantly reduced risk of death in the hospital but with an increased risk of hypoglycaemia, according to a study in the August 27 issue of the Journal of the American Medical Association. This finding calls into question the recommendation by many professional societies for tight glucose control for these patients. In 2001, a randomised, controlled trial by van den Berghe and colleagues showed that tight glucose control for critically ill surgical patients reduced hospital mortality by one-third.(1) "Because few interventions in critically ill adult patients reduce mortality to this extent, the results of this trial were enthusiastically received and rapidly incorporated into guidelines," the authors wrote. Numerous organisations, including the American Diabetes Association and the American Association of Clinical Endocrinologists, now recommend tight glucose control in all critically ill adults. "These recommendations have led to worldwide adoption of tight glucose control in a variety of intensive care unit [ICU] settings." But some subsequent trials of tight glucose control in certain ICU settings have failed to show the mortality benefit and have indicated an increased risk for hypoglycaemia. Renda Soylemez Wiener, MD, Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Medical School, Hanover, New Hampshire, and colleagues conducted a meta-analysis of 29 randomised, controlled trials to examine the risks and benefits of tight glucose control compared with usual care in critically ill adults. The meta-analysis included data for 8,432 patients. The researchers found that among these trials, there was no significant difference in hospital mortality between tight glucose control and usual care strategies (21.6% vs 23.3%) and no significant difference in hospital mortality when stratified by surgical, medical, and medical-surgical ICU setting. Tight glucose control was not associated with a significantly decreased risk for new need for dialysis (11.2% vs 12.1%) but was associated with a significantly decreased risk of septicaemia (10.9% vs 13.4%). The risk of hypoglycaemia was increased about 5-fold (13.7% vs 2.5%). "Given the overall findings of this meta-analysis, it seems appropriate that the guidelines recommending tight glucose control in all critically ill patients should be re-evaluated until the results of larger, more definitive clinical trials are available," the authors wrote. 1. van den Berghe G et al. N Engl J Med. 2001;345:1359-1367. SOURCE: Journal of the American Medical Association --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.