Impact of prolonged requirement for insulin on 90-day mortality in critically ill patients without previous diabetic treatments: a post hoc analysis of the CONTROLING randomized control trial.
Critical care
Mortality
Prolonged requirement for insulin
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
16 05 2022
16 05 2022
Historique:
received:
16
12
2021
accepted:
27
04
2022
entrez:
16
5
2022
pubmed:
17
5
2022
medline:
20
5
2022
Statut:
epublish
Résumé
Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments. This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5. A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54-76) years. Median values for SAPS II and HbA1C were 50 (37.5-64) and 5.7 (5.4-6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality ( In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results.
Sections du résumé
BACKGROUND
Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments.
METHODS
This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5.
RESULTS
A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54-76) years. Median values for SAPS II and HbA1C were 50 (37.5-64) and 5.7 (5.4-6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group (p < 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality (
CONCLUSION
In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results.
Identifiants
pubmed: 35578303
doi: 10.1186/s13054-022-04004-1
pii: 10.1186/s13054-022-04004-1
pmc: PMC9109308
doi:
Substances chimiques
Blood Glucose
0
Glycated Hemoglobin A
0
Insulin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
138Informations de copyright
© 2022. The Author(s).
Références
Diabetes Care. 2008 Aug;31(8):1473-8
pubmed: 18540046
Acta Anaesthesiol Taiwan. 2013 Jun;51(2):67-72
pubmed: 23968657
Crit Care Med. 2005 Dec;33(12):2772-7
pubmed: 16352959
Am J Physiol. 1979 Sep;237(3):E214-23
pubmed: 382871
Metabolism. 2007 Jan;56(1):1-5
pubmed: 17161218
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Mayo Clin Proc. 2010 Mar;85(3):217-24
pubmed: 20176928
Endocr Pract. 2015 Apr;21 Suppl 1:1-87
pubmed: 25869408
Crit Care. 2010;14(5):R166
pubmed: 20840773
Crit Care. 2014 Oct 28;18(5):586
pubmed: 25349023
Intensive Care Med. 2016 Apr;42(4):562-571
pubmed: 26846519
Clin Endocrinol (Oxf). 2006 Feb;64(2):141-5
pubmed: 16430711
J Intensive Care. 2021 Jan 12;9(1):8
pubmed: 33436084
Acta Anaesthesiol Scand. 2015 Jul;59(6):710-22
pubmed: 25867209
Curr Diab Rep. 2017 Nov 2;17(12):133
pubmed: 29098423
Surg Infect (Larchmt). 2015 Oct;16(5):490-7
pubmed: 26270204
Intensive Care Med. 2022 Jan;48(1):128-129
pubmed: 34750649
Crit Care. 2017 Jun 24;21(1):152
pubmed: 28645302
Crit Care Resusc. 2014 Mar;16(1):13-23
pubmed: 24588431
Crit Care. 2016 Nov 4;20(1):358
pubmed: 27814776
Crit Care. 2013 Mar 06;17(2):305
pubmed: 23470218
Stat Med. 2007 Feb 20;26(4):734-53
pubmed: 16708349
Biomed Eng Online. 2014 Apr 16;13:43
pubmed: 24739335
Crit Care. 2010;14(4):231
pubmed: 20727232
Crit Care Med. 2009 Dec;37(12):3001-9
pubmed: 19661802
N Engl J Med. 2009 Mar 26;360(13):1283-97
pubmed: 19318384
Trials. 2011 Jan 24;12:21
pubmed: 21261975
Stat Med. 2015 Dec 10;34(28):3661-79
pubmed: 26238958
J Trauma Acute Care Surg. 2013 Jan;74(1):270-5
pubmed: 23271103
Intensive Care Med. 2021 Nov;47(11):1271-1283
pubmed: 34590159
Am J Physiol Renal Physiol. 2005 Aug;289(2):F259-64
pubmed: 15840772
Ther Adv Endocrinol Metab. 2018 Jun 03;9(8):223-230
pubmed: 30181848
Best Pract Res Clin Anaesthesiol. 2009 Dec;23(4):375-86
pubmed: 20108577
Surg Infect (Larchmt). 2008 Apr;9(2):121-30
pubmed: 18426344
Surg Infect (Larchmt). 2014 Dec;15(6):713-20
pubmed: 25215464
Stat Med. 2012 Jun 15;31(13):1380-404
pubmed: 22362629
N Engl J Med. 2015 Jun 18;372(25):2398-408
pubmed: 25992505
Clin Microbiol Infect. 2019 Mar;25(3):359-364
pubmed: 29870854
Crit Care Med. 2013 Jun;41(6):e93-4
pubmed: 23685597