title: Liberal Versus Conventional Glucose Targets in Critically Ill Diabetic Patients: An Exploratory Safety Cohort Assessment.
abstract: OBJECTIVE
  To assess the feasibility, safety, and impact on relative hypoglycemia of liberal versus conventional blood glucose concentration targets in critically ill diabetic patients.
  
  
  METHODS
  Prospective, open-label, sequential-period exploratory study.
  
  
  METHODS
  A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia.
  
  
  METHODS
  Eighty adult diabetic patients, 40 from the conventional before period and 40 from the liberal after period.
  
  
  METHODS
  Blood glucose concentration targets were 6-10 mmol/L during the before period and 10-14 mmol/L during the after period.
  
  
  RESULTS
  We used admission glycated hemoglobin to estimate premorbid baseline blood glucose concentration. We defined glycemic distance as the difference between blood glucose concentration in ICU and baseline blood glucose concentration. During the first 48 ICU hours, we recorded absolute (blood glucose concentration, < 3.9 mmol/L) and relative (glycemic distance, > 30% below baseline) hypoglycemia rates, insulin administration, and outcomes. The groups had similar baseline characteristics. We observed a negative glycemic distance in 248 of 488 blood glucose concentrations (50.8%) during the before period and 164 of 485 (33.8%) during the after period (p < 0.001). We detected relative hypoglycemia in 20 (50.0%) and nine (22.5%) patients in the before and after periods, respectively (p = 0.01). On day 1, 50.0% and 16.7% received insulin in the before and after periods (p = 0.007). ICU and hospital length of stay and mortality were similar between groups.
  
  
  CONCLUSIONS
  In a safety cohort of critically ill diabetic patients, a blood glucose concentration target of 10-14 mmol/L resulted in fewer episodes of negative glycemic distance or relative hypoglycemia and reduced insulin administration compared with a target of 6-10 mmol/L.
authors.affiliation: 1Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.2Department of Anesthesia and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Roma, Italy.3Department of Perioperative Medicine, Intensive Care and Emergency, Università degli Studi di Trieste, Ospedale di Cattinara, Trieste, Italy.4Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia.5Department of Intensive Care, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.6Department of Endocrinology and Diabetology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.7Department of Medicine Austin Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia.8Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solnavägen, Solna, Sweden.
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Muzio
authors.forename: Barbara
authors.initials: B
authors.lastname: Presello
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Glassford
authors.forename: Isabela Y
authors.initials: IY
authors.lastname: Tsuji
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.forename: Elif I
authors.initials: EI
authors.lastname: Ekinci
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Johan
authors.initials: J
authors.lastname: Mårtensson
mesh_terms: D000368:Aged; D001315:Australia; D001786:Blood Glucose / Q000378:metabolism*; D065187:Controlled Before-After Studies; D003422:Critical Care; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin