Lower Glucose Target Is Associated With Improved 30-Day Mortality in Cardiac and Cardiothoracic Patients

Area of Science:

• Critical Care Medicine
• Endocrinology
• Cardiovascular Medicine

Background:

• Existing guidelines advise against intensive insulin therapy for critically ill patients due to high hypoglycemia risks.
• Intermountain Healthcare utilizes a computerized IV insulin protocol with selectable blood glucose (BG) targets (80-110 vs. 90-140 mg/dL) and achieves low severe hypoglycemia rates.

Purpose of the Study:

• To investigate the impact of different blood glucose (BG) targets on mortality in adult cardiac ICU patients under a protocol with very low rates of severe hypoglycemia.

Main Methods:

• A propensity score analysis was used to compare 30-day mortality between critically ill patients treated with IV insulin targeting 80-110 mg/dL versus 90-140 mg/dL.
• Factors influencing the clinicians' choice of BG target were used to create a propensity score for adjustment.

Main Results:

• 1,809 patients were included; baseline characteristics were similar between groups.
• The 80-110 mg/dL group had lower median glucose (104 vs. 122 mg/dL) and significantly lower unadjusted 30-day mortality (4.3% vs. 9.2%).
• Propensity score-adjusted analysis confirmed that the 80-110 mg/dL target was associated with reduced 30-day mortality (OR, 0.65; 95% CI, 0.43-0.98).

Conclusions:

• Tight glucose control (80-110 mg/dL) in cardiac ICU patients, when implemented with a protocol ensuring low severe hypoglycemia rates, is linked to decreased 30-day mortality.
• The findings support re-evaluating the use of tight glucose control in clinical practice under such optimized protocols.