1
|
Defante MLR, Mendes BX, de Souza MDM, De Hollanda Morais BADA, Martins OC, Prizão VM, Parolin SAEC. Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials. J Intensive Care Med 2024:8850666241255671. [PMID: 38751353 DOI: 10.1177/08850666241255671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.
Collapse
Affiliation(s)
- Maria L R Defante
- Department of Medicine, Redentor University Center, Itaperuna, Brazil
| | | | | | | | | | | | | |
Collapse
|
2
|
Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial. Transplant Proc 2023; 55:170-177. [PMID: 36567173 DOI: 10.1016/j.transproceed.2022.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. METHODS We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. RESULTS Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). CONCLUSIONS Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.
Collapse
|
4
|
Nichols JH, Brandler ES, Fantz CR, Fisher K, Goodman MD, Headden G, Hoppensteadt D, Matika R, Peacock WF, Rodrigo J, Schützenmeister A, Swanson JR, Canada-Vilalta C, Miles G, Tran N. A Multicenter Evaluation of a Point-of-Care Blood Glucose Meter System in Critically Ill Patients. J Appl Lab Med 2021; 6:820-833. [PMID: 33837390 DOI: 10.1093/jalm/jfab005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Our purpose was to evaluate the performance of the ACCU-CHEK® Inform II blood glucose monitoring system (Roche Diagnostics GmbH) compared with the perchloric acid hexokinase (PCA-HK) comparator method on the cobas® 6000 analyzer (Roche Diagnostics International Ltd) in critically ill patients. METHODS Overall, 476 arterial (376 pediatric/adult, 100 neonate), 375 venous, and 100 neonatal heel-stick whole-blood samples were collected and evaluated from critical care settings at 10 US hospitals, including the emergency department, medical and surgical intensive care units (ICUs), and neonatal and pediatric ICUs. The ACCU-CHEK Inform II system was evaluated at 2 cutoff boundaries: boundary 1 was ≥95% of results within ±12 mg/dL of the reference (samples with blood glucose <75 mg/dL) or ±12% of the reference (glucose ≥75 mg/dL), and boundary 2 was ≥98% of results within ±15 mg/dL or ±15% of the reference. Clinical performance was assessed by evaluating sample data using Parkes error grid, Monte Carlo simulation, and sensitivity and specificity analyses to estimate clinical accuracy and implications for insulin dosing when using the ACCU-CHEK Inform II system. RESULTS Proportions of results within evaluation boundaries 1 and 2, respectively, were 96% and 98% for venous samples, 94% and 97% for pediatric and adult arterial samples, 84% and 98% for neonatal arterial samples, and 96% and 100% for neonatal heel-stick samples. Clinical evaluation demonstrated high specificity and sensitivity, with low risk of potential insulin-dosing errors. CONCLUSIONS The ACCU-CHEK Inform II system demonstrated clinically acceptable performance against the PCA-HK reference method for blood glucose monitoring in a diverse population of critically ill patients in US care settings.
Collapse
Affiliation(s)
- James H Nichols
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Corinne R Fantz
- Roche Diagnostics Corporation, US Medical and Scientific Affairs, Indianapolis, IN, USA
| | | | | | - Gary Headden
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Ryan Matika
- University of Arizona Medical Center, Tucson, AZ, USA
| | | | | | | | | | | | - Gabrielle Miles
- Roche Diagnostics Operations US, Biostatistics and Data Science, Indianapolis, IN, USA
| | - Nam Tran
- UC Davis Health, Sacramento, CA, USA
| |
Collapse
|
7
|
Ben Hamou A, Kipnis E, Elbaz A, Bignon A, Nseir S, Tamion F, Du Cheyron D, Jaillette E, Voisin B, Robriquet L, Vanbaelinghem C, Thellier D, Abi Rached H, Jannin A, Duhamel A, Behal H, Machuron F, Espiard S, Preiser JC, Preau S, Pattou F, Jourdain M. Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study. DIABETES & METABOLISM 2019; 46:243-247. [PMID: 31121319 DOI: 10.1016/j.diabet.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose≥11mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. METHODS This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012-2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for<48h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded. MAIN RESULTS The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB-G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P=0.078): OR(peroneTcopy): 1.24, 95% CI: 0.98-1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P=0.026), but was no longer significant at 1 year (P=0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43-3.06; P<0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32-2.28; P<0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07-4.20; P=0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71-2.96; P=0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P=0.72) or 1 year (P=0.64). CONCLUSION This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.
Collapse
Affiliation(s)
- A Ben Hamou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - E Kipnis
- Medical School, université de Lille, 59000 Lille, France; Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France; EA 7366-Host Pathogen Translational Research, université de Lille, 59000 Lille, France
| | - A Elbaz
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - A Bignon
- Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France
| | - S Nseir
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - F Tamion
- Intensive Care Unit, CHU de Rouen, 76031, Rouen, France; UMR 1096 Inserm-Université de Rouen-Biologie, médecine, santé-Endothélium, Valvulopathies et Insuffisance Cardiaque, 76031 Rouen, France
| | - D Du Cheyron
- Intensive Care Unit, CHU de Caen, 14033 Caen, France
| | - E Jaillette
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - B Voisin
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - L Robriquet
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - C Vanbaelinghem
- Intensive Care Unit, Victor Provo Hospital Center, 59100 Roubaix, France
| | - D Thellier
- Intensive Care Unit, Guy Chatiliez Hospital Center, 59200 Tourcoing, France
| | - H Abi Rached
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Jannin
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Duhamel
- Medical School, université de Lille, 59000 Lille, France; EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - H Behal
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - F Machuron
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - S Espiard
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - J-C Preiser
- Department of Intensive Care, CUB-Erasme, université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Preau
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - F Pattou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France
| | - M Jourdain
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France; PRESAGE Simulation Center, université de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France.
| |
Collapse
|