title: Hypoglycaemia and predisposing factors among clinical subgroups treated with intensive insulin therapy.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany.
authors.forename: R M
authors.initials: RM
authors.lastname: Waeschle
authors.forename: A
authors.initials: A
authors.lastname: Bräuer
authors.forename: R
authors.initials: R
authors.lastname: Hilgers
authors.forename: P
authors.initials: P
authors.lastname: Herrmann
authors.forename: P
authors.initials: P
authors.lastname: Neumann
authors.forename: M
authors.initials: M
authors.lastname: Quintel
authors.forename: O
authors.initials: O
authors.lastname: Moerer
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D015984:Causality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin