A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study

Preiser, Jean Charles; Devos, Philippe; Ruiz‐Santana, Sergio; Mélot, Christian; Annane, Djillali; Groeneveld, Johan; Iapichino, G.; Leverve, Xavier; Nitenberg, Gérard; Singer, Pierre; Wernerman, Jan; Joannidis, Michael; Stecher, Adela; Chioléro, René

doi:10.1007/s00134-009-1585-2

Cited by 804 publications

(635 citation statements)

References 34 publications

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“…Hypoglycemia, as noted, is also a major cause of TGC difficulty, as it stopped the neonatal NIRTURE TGC study [51], and was a factor in stopping both VISEP and Glucontrol [44,46]. Almost all studies report increased hypoglycemia with intensive TGC [43], excepting SPRINT [34].…”

Section: Hyperglycemia Hypoglycemia Tgc and Patient Mortality Outcomementioning

confidence: 99%

“…However, other studies did not get a similar result [40][41][42][43][44][45][46], with some stopped for safety due to hypoglycemia [44] or unintended protocol violations [46]. The recent NICE-SUGAR study [45] reported an increase in mortality in the TGC arm with a lower glycemic target, but was also subject to criticism of its treatment approach, analysis and randomisation methods [47][48][49][50].…”

Section: Hyperglycemia Hypoglycemia Tgc and Patient Mortality Outcomementioning

confidence: 99%

“…• Adult ICU (ICU2): N = 211 patients from Glucontrol trial pilot study (both A and B cohorts) at the CHU de Liege in Liege, Belgium with over 30,000 hours of data [46].…”

Section: Analysing Insulin Sensitivity In the Critically Illmentioning

confidence: 99%

“…Hence, the ICU1 cohort from SPRINT has significantly less interpatient variability with a much smaller S I range than the NICU cohort. [3,45,46,66]). With 50% of all likely variations spanning +/-30% over 4 hours, even these more likely variations can result in significant swings in blood glucose for a given consistent intervention.…”

Section: Analysing Insulin Sensitivity In the Critically Illmentioning

confidence: 99%

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Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

Self Cite

119

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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Section: Hyperglycemia Hypoglycemia Tgc and Patient Mortality Outcomementioning

confidence: 99%

Section: Hyperglycemia Hypoglycemia Tgc and Patient Mortality Outcomementioning

confidence: 99%

“…• Adult ICU (ICU2): N = 211 patients from Glucontrol trial pilot study (both A and B cohorts) at the CHU de Liege in Liege, Belgium with over 30,000 hours of data [46].…”

Section: Analysing Insulin Sensitivity In the Critically Illmentioning

confidence: 99%

Section: Analysing Insulin Sensitivity In the Critically Illmentioning

confidence: 99%

See 2 more Smart Citations

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

Self Cite

119

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“…Our analysis included 14,495 patients from 27 studies 128, 330, 331, 332, 337, 338, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359. None of the studies were especially prone to bias.…”

Section: Cq14: Blood Glucose Managementmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Tight Glycemic Control in Critically Ill Patients

Castellanos¹

2010

JAMA

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A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study

Cited by 804 publications

References 34 publications

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Tight Glycemic Control in Critically Ill Patients

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