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Retrospective outcomes of glucose control in critically ill children

Sarah B Kandil1, Debra Spear, Neal J Thomas

  • 1Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, 333 Cedar St., P.O. Box 208064, New Haven, CT 06520-8064. sarah.kandil@yale.edu.

Journal of Diabetes Science and Technology
|October 16, 2013
PubMed

Insights

Controlling high blood glucose (BG) in critically ill children with insulin did not improve outcomes and was associated with fewer intensive care unit (ICU)-free days. Further randomized trials are needed to clarify glucose control benefits.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Metabolic Disorders

Background:

  • Hyperglycemia is a common and concerning issue in critically ill children.
  • Current treatment strategies for hyperglycemia in this population lack consensus.
  • This study investigates the impact of blood glucose control interventions.

Purpose of the Study:

  • To evaluate the effect of insulin therapy for hyperglycemia on outcomes in critically ill children.
  • To compare outcomes between hyperglycemic children receiving insulin and those not receiving interventions.

Main Methods:

  • Retrospective cohort study comparing a treatment group (insulin for BG ≥ 150 mg/dl) with a historical baseline group.
  • Included nondiabetic critically ill children requiring mechanical ventilation and/or vasopressors.
  • Analyzed intensive care unit (ICU)-free days, ventilator-free days, vasopressor-free days, and mortality.

Main Results:

  • The treatment group (n=130) had lower mean BG (140 mg/dl) than the baseline group (n=137, 179 mg/dl).
  • The treatment group experienced 2.5 fewer ICU-free days (p=.023) after adjustment.
  • No significant association found between glucose control and ICU stay duration, ventilator/vasopressor-free days, or mortality.

Conclusions:

  • Blood glucose control in critically ill children may be associated with adverse outcomes.
  • Conflicting evidence from adult studies necessitates caution.
  • Strong recommendation for randomized controlled trials to definitively assess glucose control efficacy in pediatric critical care.
Abstract

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