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Intensive glucose control for critically ill patients: an updated meta-analysis
Yongli Fu1, Yaowu Sun2, Jiankun Zhang3
1Department of Endocrinology, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang Province, People's Republic of China.
Endocrine Connections
|October 24, 2018
Summary
Intensive glucose control in critically ill patients did not reduce mortality or sepsis risk. However, it significantly increased the risk of hypoglycemia, a critical safety concern for these patients.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Clinical Trials Methodology
Background:
- Critically ill patients often experience hyperglycemia, necessitating glucose management strategies.
- Intensive glucose control (IGC) aims to maintain blood glucose levels within a narrow, lower range.
- Previous evidence on IGC's efficacy and safety in critical care has been conflicting.
Purpose of the Study:
- To update the evidence on the effects of intensive glucose control versus conventional glucose control in critically ill patients.
- To evaluate IGC's impact on mortality, sepsis, and renal outcomes.
- To assess the safety profile of IGC, particularly the risk of hypoglycemia.
Main Methods:
- Systematic literature review and meta-analysis of randomized clinical trials (RCTs) published up to December 2017.
- Searched major databases: PubMed, EMBASE, and Cochrane Library.
- Applied random-effect models to calculate summary relative risks (RRs) for various outcomes.
Main Results:
- IGC did not significantly decrease short-term (in-hospital/ICU) or 3- to 6-month mortality (RR 0.99, 95% CI 0.92-1.06; RR 1.02, 95% CI 0.97-1.08).
- No significant reduction in the risk of sepsis (RR 1.00, 95% CI 0.89-1.11) or new need for dialysis (RR 0.97, 95% CI 0.84-1.11) was observed with IGC.
- IGC was associated with a nearly 4-fold increase in the risk of hypoglycemia (RR 4.86, 95% CI 3.16-7.46).
Conclusions:
- Updated meta-analysis indicates IGC offers no significant mortality benefit for critically ill patients.
- IGC does not reduce the risk of sepsis or the need for dialysis in this population.
- The significantly higher risk of hypoglycemia underscores safety concerns associated with IGC in critical care settings.
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