title: SAFETY AND EFFICACY OF PERSONALIZED GLYCEMIC CONTROL IN CRITICALLY ILL PATIENTS: A 2-YEAR BEFORE AND AFTER INTERVENTIONAL TRIAL.
abstract: OBJECTIVE
  To determine the safety and efficacy of a change in blood glucose (BG) control protocol from a single target to 2 targets based on diabetes mellitus (DM) status and glycated hemoglobin A1C (A1C) in a cohort of critically ill patients.
  
  
  METHODS
  This investigation includes 1,979 patients admitted to a single intensive care unit (ICU) between September 16, 2013 and September 15, 2015. The BG target was 90 to 120 mg/dL in the PRE era and 80 to 140 mg/dL for patients without diabetes (NON) and with DM with A1C <7% and 110 to 160 mg/dL for DM with A1C ≥7% (TIGHT and LOOSE protocols) in the POST era. The primary efficacy outcome was the observed:expected (O:E) mortality ratio.
  
  
  RESULTS
  Among NON, the mean BG was slightly lower in the POST era: 118 (106-132) versus 115 (101-120) mg/dL (P = .0003). Among DM, the mean BG was 139 (123-160) mg/dL in the PRE era versus 136 (119-149) and 159 (138-171) mg/dL for TIGHT and LOOSE in the POST era (P = .0668 and .0001, respectively). Overall, 11.0% and 11.8% of patients had at least 1 BG level <70 mg/dL in the 2 eras (P = .68). The O:E mortality ratios for NON and DM for the PRE and POST eras were 0.75 versus 0.74 (P = .51) and 0.69 versus 0.52 (P<.001) respectively, and among DM with A1C ≥7% were 0.74 versus 0.52 (P = .004).
  
  
  CONCLUSIONS
  This hypothesis-generating investigation suggests the need for additional prospective interventional studies assessing the outcomes of patients randomized to personalized glucose targets.
  
  
  BACKGROUND
  APACHE = Acute Physiology and Chronic Health Evaluation A1C = glycated hemoglobin A1C BG = blood glucose CV = co-efficient of variation DM = diabetes mellitus ICU = intensive care unit LOS = length of stay NON = patients without DM O:E = observed: expected.
authors.forename: James S
authors.initials: JS
authors.lastname: Krinsley
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Preiser
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D057285:Precision Medicine / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin