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Hypoglycaemia and predisposing factors among clinical subgroups treated with intensive insulin therapy
Author(s) -
WAESCHLE R. M.,
BRÄUER A.,
HILGERS R.,
HERRMANN P.,
NEUMANN P.,
QUINTEL M.,
MOERER O.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12239
Subject(s) - medicine , observational study , intensive care unit , insulin , prospective cohort study , hypoglycemia , intensive care , intensive care medicine
Background In previous studies, conflicting intensive insulin therapy ( IIT ) results have been observed, whereby IIT ‐related mortality seems to be lower in specific clinical subgroups. The aim of this study was to assess differences in glycaemic control, the risk of critical hypoglycaemia (≤ 2.2 mmol/l), the associated predisposing factors, and the in‐hospital mortality in different clinical subgroups treated with IIT . Methods Prospective, observational study in a university‐affiliated intensive care unit ( ICU ) conducted from 2004 to 2005. All patients ( n = 1667) belonging to one of the six most common surgical intervention groups (cardiac, neuro, abdominal, vascular, orthopaedic, and spinal surgeries) and medical patients were included. IIT was performed with a target blood glucose level of 4.4–7.8 mmol/l. Different indices were analysed to evaluate glucose control and glycaemic variability. Results The rate of critical hypoglycaemia was significantly different within the different clinical subgroups and varied from 0.8% to 4.5%. Similar results were obtained for hyperglycaemia. Multivariable analyses for the predisposing factors of critical hypoglycaemia showed a heterogeneous distribution pattern among the different clinical subgroups. Similar results were obtained for the risk factors of in‐hospital mortality. Conclusion The risk of critical hypoglycaemia and the associated predisposing factors depended on the clinical subgroup involved. Critical hypoglycaemia is a potential threat for our patients, and the high risk of critical hypoglycaemia in some clinical subgroups appeared to reverse the benefits of IIT . As a result, it is crucial that the different subgroups involved in a study are defined to further interpret the potential benefits of IIT and the risk of critical hypoglycaemia.