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Tight glucose control in critically ill children--a systematic review and meta-analysis

Vijay Srinivasan, Michael S D Agus

    Pediatric Diabetes
    |May 1, 2014
    PubMed

    Insights

    Tight glucose control (TGC) with intensive insulin therapy (IIT) in critically ill children did not lower mortality but reduced infections. However, this approach significantly increased hypoglycemia risk, requiring further study with continuous glucose monitoring.

    Area of Science:

    • Pediatric Critical Care Medicine
    • Endocrinology
    • Clinical Research

    Background:

    • The efficacy of tight glucose control (TGC) using intensive insulin therapy (IIT) in improving outcomes for critically ill children in the intensive care unit (ICU) remains uncertain.
    • This systematic review and meta-analysis aims to evaluate the benefits and risks associated with TGC and IIT in this vulnerable pediatric population.

    Purpose of the Study:

    • To systematically review and meta-analyze existing randomized controlled trials (RCTs) on TGC with IIT in critically ill children.
    • To identify and quantify the impact of TGC with IIT on 30-day mortality, acquired infections, and hypoglycemia.
    • To explore potential differences and trends across published studies.

    Main Methods:

    • A comprehensive literature search was conducted across major databases (MEDLINE, PubMed, EMBASE, Scopus, Web of Science, Cochrane).
    • Prospective RCTs specifically involving critically ill children were included; trials in adults and preterm neonates were excluded.
    • Data extraction focused on study design, sample size, and key outcomes: 30-day mortality, acquired infections, and hypoglycemia incidence. Meta-analytic techniques were employed for outcome analysis.

    Main Results:

    • Four RCTs comprising 3288 critically ill children were analyzed.
    • TGC with IIT did not significantly decrease 30-day mortality (OR: 0.79; 95% CI: 0.55-1.15; p = 0.22).
    • A significant reduction in acquired infections was observed (OR: 0.76; 95% CI: 0.59-0.99; p = 0.04), alongside a marked increase in hypoglycemia (OR: 6.14; 95% CI: 2.74-13.78; p < 0.001).

    Conclusions:

    • TGC with IIT in critically ill children does not improve 30-day mortality but is associated with a reduction in acquired infections.
    • A significant drawback of this approach is the increased incidence of hypoglycemia.
    • Further large, multi-center studies utilizing continuous glucose monitoring are necessary to ascertain if TGC with IIT can improve clinical outcomes without exacerbating hypoglycemia in critically ill children.
    Abstract

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