The optimal target for acute glycemic control in critically ill patients: a network meta-analysis.
OBJECTIVE
The optimal target blood glucose concentration for acute glycemic control remains unclear because few studies have directly compared 144-180 with 110-144 or >180 mg/dL. Accordingly, we performed a network meta-analysis to compare four different target blood glucose levels (<110, 110-144, 144-180, and >180 mg/dL) in terms of the benefit and risk of insulin therapy.


METHODS
We included all of the studies from three systematic reviews and searched the PubMed and Cochrane databases for other studies investigating glucose targets among critically ill patients. The primary outcome was hospital mortality, and the secondary outcomes were sepsis or bloodstream infection and the risk of hypoglycemia. Network meta-analysis to identify an optimal target glucose concentration.


RESULTS
The network meta-analysis included 18,098 patients from 35 studies. There were no significant differences in the risk of mortality and infection among the four blood glucose ranges overall or in subgroup analysis. Conversely, target concentrations of <110 and 110-144 mg/dL were associated with a four to ninefold increase in the risk of hypoglycemia compared with 144-180 and >180 mg/dL. However, there were no significant differences between the target concentrations of 144-180 and >180 mg/dL.


CONCLUSIONS
This network meta-analysis found no significant difference in the risk of mortality and infection among four target blood glucose ranges in critically ill patients, but indicated that target blood glucose levels of <110 and 110-144 mg/dL were associated with a higher risk of hypoglycemia than target levels of 144-180 and >180 mg/dL. Further studies are required to refute or confirm our findings.
Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Tomoaki
T
Yatabe
Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji, Tokyo, 192-0032, Japan.
Shigeaki
S
Inoue
Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Masahiko
M
Sakaguchi
Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. moriori@tg8.so-net.ne.jp.
Moritoki
M
Egi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D016638:Critical Illness / Q000628:therapy*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D007004:Hypoglycemic Agents
Critical illness; Glycemic control; Network meta-analysis; Optimal target
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