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Severe hypoglycemia during intensive insulin therapy
K-M Kaukonen1, M Rantala, V Pettilä
1Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. maija.kaukonen@hus.fi
Acta Anaesthesiologica Scandinavica
|October 24, 2008
Summary
Severe hypoglycemia is rare in intensive insulin therapy, affecting only 2.3% of patients. This study found no significant difference in mortality between patients who experienced severe hypoglycemia and those who did not.
Area of Science:
- Intensive care medicine
- Endocrinology
- Clinical research
Background:
- Tight glycemic control is crucial for reducing mortality in intensive care unit (ICU) patients.
- Previous studies on intensive insulin therapy were halted due to safety concerns, questioning its clinical application.
- The incidence and impact of hypoglycemia during intensive insulin therapy require further investigation.
Purpose of the Study:
- To determine the incidence of severe hypoglycemia in patients undergoing intensive insulin therapy.
- To evaluate the effects of severe hypoglycemia on patient outcomes in the ICU.
Main Methods:
- A prospective study was conducted in two tertiary care hospital ICUs over 17 months.
- Nurse-driven intensive insulin therapy targeting blood glucose of 4-6 mmol/l was implemented.
- Patients were categorized based on the occurrence of severe hypoglycemia (glucose ≤2.2 mmol/l).
Main Results:
- Out of 1224 patients, severe hypoglycemia occurred in 2.3% of patients (36 measurements).
- No significant differences were observed in patient demographics, severity scores, or length of stay between groups.
- Hospital mortality rates were 25% for patients with severe hypoglycemia versus 15% for those without (P=0.16).
Conclusions:
- Severe hypoglycemia is infrequent in clinical practice when employing intensive insulin therapy.
- The study suggests that severe hypoglycemia may not significantly impact mortality in the ICU setting compared to previous trial data.
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