Application of conventional blood glucose control strategy in surgical ICU in developing countries: Is it beneficial?

Abstract

Background: Hyperglycemia is common among critically ill patients and is associated with increased morbidity and mortality and there is no clear answer to the question: which to apply tight or conventional glycemic control? Objective: Evaluation and comparison of the effects of tight versus conventional glycemic control on critically ill patients in our surgical intensive care unit (ICU). Design: Prospective randomized controlled trial. Methods: 120 Patients were divided into two groups: group (I) received intensive insulin therapy targeting blood glucose level between 80 and 110 mg/dl, who referred to as intensive treatment group, and group (II) received conventional insulin therapy targeting blood glucose level between 150 and 200 mg/dl, and referred to as conventional treatment group. Results: 120 Patients were enrolled in the study, the incidence of hypoglycemia (blood glucose <70 mg/dl) was 29.09% in group I who received intensive insulin therapy versus 6.15% in group II who received conventional insulin therapy (p value 0.000) with no demonstrable complications, regarding mortality rate, impairment of Liver function tests, change in total leukocytic count, the need for red blood cell transfusion, ICU stay and Total hospital stay and we reported no statistical significant difference between the two groups. Conclusion: Tight glycemic control for critically ill patients in ICU in poor resources countries showed increased incidence of hypoglycemia with no significant benefits when compared with conventional glycemic control.

Practice of hyperglycaemia control in intensive care units of the Military Hospital, Sudan—Needs of a protocol

“…While, mixed insulin method did not achieve the target glycaemic range as already reported by Marik P.E et al [ 10 ]. Sliding scale method achieved the target range in only 9.1% of the patients of our study; consistent with published literature [ 8 , 19 , 40 ] recommending the use of insulin infusions in ICU patients to achieve the NICE-SUGAR range which had proven efficacy and safety in low-income countries [ 41 ].…”

Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024

“…There was no impact on hospital mortality (23 RCTs [1, 14–35]; relative risk [RR], 0.91; 95% CI, 0.8–1.02; moderate certainty) or ICU mortality (18 RCTs [1, 2, 14–16, 18, 20–24, 27–29, 36–39]; RR, 0.97; 95% CI, 0.91–1.03; high certainty). Targeting INT was associated with lower ICU length of stay (LOS, 25 studies [1, 2, 14–16, 18–20, 23–29, 31–35, 38, 40–43]; mean difference [MD], –0.48; 95% CI, –0.82 to –0.14; low certainty), reduced infection risk (24 studies [1, 2, 14, 16, 18–20, 22, 24–27, 29–31, 37, 38, 40, 42, 44–48]; RR, 0.79; 95% CI, 0.68–0.91; moderate certainty), and increased frequency of severe hypoglycemia (< 2.2 mmol/L) (29 RCTs [1, 2, 14–28, 35–38, 40–43, 45–47, 49]; RR, 3.75; 95% CI, 2.38–5.9; high certainty). Although INT improved neurologic outcomes in six studies (26, 27, 31, 45, 50, 51) and reduced critical illness polyneuropathy in two (1, 52), all had serious risk of bias (SDC 9-2, http://links.lww.com/CCM/H476).…”

Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024: Executive Summary

“…Clinical benefits of INT have not been consistently demonstrated in the RCTs included in our meta-analysis; specifically no effect is shown on mortality among mixed populations of ICU patients. However, INT targets were associated with increased frequency of severe hypoglycemia, less than 2.2 mmol/L (40 mg/dL) compared with CONV targets, although there was a reduced infection risk, and lower ICU length of stay (LOS) with INT vs. CONV targets (5–42). In neurologic and cardiac surgery subsets, INT targets were associated with increased risk of severe hypoglycemia and although the cardiac surgery subset had a lower ICU mortality and lower critical illness polyneuropathy (both from a single clinical trial) there were no other outcome benefits (hospital mortality, any infection) (5, 25–31, 40–44).…”