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A Patient-Level Meta-Analysis of Intensive Glucose Control in Critically Ill Adults
Derick Adigbli1,2,3,4, Yang Li1, Naomi Hammond1,5
1Critical Care Division, The George Institute for Global Health, Sydney.
NEJM Evidence
|June 12, 2024
Summary
Intensive glucose control in critically ill patients did not reduce mortality risk. This approach, however, significantly increased the risk of severe hypoglycemia without identified patient subgroups benefiting from it.
Area of Science:
- Critical care medicine
- Metabolic disorders
- Clinical trials
Background:
- The impact of intensive glucose control on mortality in critically ill patients remains uncertain.
- Patient-level meta-analyses are crucial for precise treatment effect estimation.
Purpose of the Study:
- To determine if intensive glucose control reduces mortality in critically ill adults.
- To evaluate secondary outcomes including survival and treatment cessation.
- To assess the safety of intensive glucose control, specifically severe hypoglycemia.
Main Methods:
- Pooled individual patient data from 20 randomized trials (14,171 participants).
- Primary outcome: in-hospital mortality.
- Safety outcome: severe hypoglycemia.
Main Results:
- Intensive glucose control (n=7059) showed no significant reduction in in-hospital mortality compared to conventional control (n=7049) (risk ratio, 1.02; P=0.52).
- No heterogeneity of treatment effect was observed across subgroups.
- Severe hypoglycemia risk was significantly higher with intensive control (risk ratio, 3.38; P<0.0001).
Conclusions:
- Intensive glucose control in critically ill adults is not associated with reduced mortality.
- The risk of severe hypoglycemia is increased with intensive glucose control.
- No specific patient subgroup demonstrated a benefit from intensive glucose control.
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