title: Effect of different blood glucose target levels on the incidence of hypoglycemia during insulin therapy in the intensive care unit.
abstract: BACKGROUND
  Prior to 2003, the target blood glucose level at our institute was <200 mg/dL. This target was reassessed in 2004 and again in 2006 based on reports showing decreased mortality in patients with target glucose levels between 80 and 110 mg/dL and results from subsequent randomized controlled trials. The aim of the present study was to determine the incidence of hypoglycemia due to IIT. The primary endpoint of the study was the incidence of hypoglycemia, with secondary outcomes of morbidity and mortality in three different periods.
  
  
  METHODS
  A total of 2038 patients admitted to the intensive care unit (ICU) were divided into three groups with different target blood glucose levels: Group H, <200 mg/dL; Group M, <150 mg/dL; and Group L, <120 mg/dL. The incidence of hypoglycemia and patient outcomes in the three groups were compared.
  
  
  RESULTS
  The incidence of serious hypoglycemia (<40 mg/dL) in Groups H, M and L was 3.5%, 4.0%, and 5.4%, respectively; the incidence of moderate hypoglycemia (<60 mg/dL) was 9.4%, 11.7%, and 21.0% (P < 0.01), respectively. There were no significant differences among the groups in terms of days connected to the ventilator, length of ICU stay and ICU mortalities.
  
  
  CONCLUSIONS
  The incidence of moderate hypoglycemia (<60 mg/dL) was significantly increased during the period when the target blood glucose level was <120 mg/dL. Changes in target blood glucose levels did not affect patient mortality.
authors.affiliation: Intensive Care Medicine, Gunma University Hospital, Maebashishi, Japan. mokawa@gunma-u.ac.jp
authors.forename: Makio
authors.initials: M
authors.lastname: Okawa
authors.forename: Fumio
authors.initials: F
authors.lastname: Kunimoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kanamoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Narahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hinohara
authors.forename: Masaru
authors.initials: M
authors.lastname: Tobe
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yanagisawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood*; D015994:Incidence; D007328:Insulin / Q000009:adverse effects*; D007362:Intensive Care Units; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin