Clinical challenges of glycemic control in the intensive care unit: A narrative review

Sreedharan, Roshni; Martini, Adriana Maria Zanforlin; Das, Gyan; Aftab, Nida; Khanna, Sandeep; Ruetzler, Kurt

doi:10.12998/wjcc.v10.i31.11260

Cited by 7 publications

(4 citation statements)

References 54 publications

(71 reference statements)

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“…In the context of sepsis patients, hyperglycemia is a common bystander associated with severity of disease and mortality (23). Studies have shown that frequent glucose measurements are associated with less hypoglycemia and hyperglycemia episodes, as well as decreased glucose variability (45)(46)(47)(48) which has been associated with decreased hospital mortality, decreased length of hospital stay, and composite hospital complications (48).…”

Section: Discussionmentioning

confidence: 99%

Variation in monitoring: Glucose measurement in the ICU as a case study to preempt spurious correlations

Teotia,

Jia,

Woite

et al. 2023

Preprint

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ObjectiveHealth inequities can be influenced by demographic factors such as race and ethnicity, proficiency in English, and biological sex. Disparities may manifest as differential likelihood of testing which correlates directly with the likelihood of an intervention to address an abnormal finding. Our retrospective observational study evaluated the presence of variation in glucose measurements in the Intensive Care Unit (ICU).MethodsUsing the MIMIC-IV database (2008-2019), a single-center, academic referral hospital in Boston (USA), we identified adult patients meeting sepsis-3 criteria. Exclusion criteria were diabetic ketoacidosis, ICU length of stay under 1 day, and unknown race or ethnicity. We performed a logistic regression analysis to assess differential likelihoods of glucose measurements on day 1. A negative binomial regression was fitted to assess the frequency of subsequent glucose readings. Analyses were adjusted for relevant clinical confounders, and performed across three disparity proxy axes: race and ethnicity, sex, and English proficiency.ResultsWe studied 24,927 patients, of which 19.5% represented racial and ethnic minority groups, 42.4% were female, and 9.8% had limited English proficiency. No significant differences were found for glucose measurement on day 1 in the ICU. This pattern was consistent irrespective of the axis of analysis, i.e. race and ethnicity, sex, or English proficiency. Conversely, subsequent measurement frequency revealed potential disparities. Specifically, males (incidence rate ratio (IRR) 1.06, 95% confidence interval (CI) 1.01 - 1.21), patients who identify themselves as Hispanic (IRR 1.11, 95% CI 1.01 - 1.21), or Black (IRR 1.06, 95% CI 1.01 - 1.12), and patients being English proficient (IRR 1.08, 95% CI 1.01 - 1.15) had higher chances of subsequent glucose readings.ConclusionWe found disparities in ICU glucose measurements among patients with sepsis, albeit the magnitude was small. Variation in disease monitoring is a source of data bias that may lead to spurious correlations when modeling health data.

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Section: Discussionmentioning

confidence: 99%

Variation in monitoring: Glucose measurement in the ICU as a case study to preempt spurious correlations

Teotia,

Jia,

Woite

et al. 2023

Preprint

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“…Several randomized controlled trials have demonstrated the protective role of avoidance of hyperglycemia, early parenteral nutrition and reducing excessive sedation[ 7 ]. The present approach encourages liberal glycemic control (7.8-10.0 mmol/L) in very sick patients[ 8 ]. Neuromuscular electrical stimulation applied to limb muscles also has a positive effect in mechanically ventilated patients, and this effect is enhanced by combining it with physical therapy[ 9 ].…”

Section: To the Editormentioning

confidence: 99%

Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship

Sinha,

Nishant

et al. 2024

World J Clin Cases

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Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81) is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause. The risk factors for ICU-AW include hyperglycemia, parenteral nutrition, vasoactive drugs, neuromuscular blocking agents, corticosteroids, sedatives, some antibiotics, immobilization, the disease severity, septicemia and systemic inflammatory response syndrome, multiorgan failure, prolonged mechanical ventilation (MV), high lactate levels, older age, female sex, and pre-existing systemic morbidities. There is a definite association between the duration of ICU stay and MV with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors. Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.

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“…In the case of SAP, overt beta cell destruction directly leads to the development of diabetes, but it is not clear to what extent beta cell injury occurs following MAP. During acute illness, a well characterized systemic stress response occurs, including an increase in inflammatory cytokine and counterregulatory hormone to insulin that leads to widespread insulin resistance and hyperglycemia [16].…”

Section: Biological Mechanismsmentioning

confidence: 99%

Risk and factors determining diabetes after mild, nonnecrotizing acute pancreatitis

Pichardo-Lowden,

Goodarzi,

Trikudanathan

et al. 2024

Current Opinion in Gastroenterology

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Purpose of review Diabetes mellitus (DM) is relatively common following acute pancreatitis (AP), even after mild acute pancreatitis (MAP), the most frequent AP presentation, in which there is no overt beta cell injury. Post-AP related diabetes is widely misdiagnosed, resulting in potentially inappropriate treatment and worse outcomes than type 2 diabetes (T2D). Thus, it is important to understand risk across the spectrum of AP severity. Recent findings Biological mechanisms are unclear and may include local and systemic inflammation leading to beta cell dysfunction and insulin resistance, altered gut barrier and/or gut peptides and possibly islet autoimmunity, though no studies have specifically focused on MAP. While studies examining clinical risk factors on MAP exclusively are lacking, there are studies which include MAP. These studies vary in scientific rigor, approaches to rule out preexisting diabetes, variable AP severity, diagnostic testing methods, and duration of follow-up. Overall, disease related factors, including AP severity, as well as established T2D risk factors are reported to contribute to the risk for DM following AP. Summary Though numerous studies have explored risk factors for DM after AP, few studies specifically focused on MAP, highlighting a key knowledge gap that is relevant to the majority of patients with AP.

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Clinical challenges of glycemic control in the intensive care unit: A narrative review

Cited by 7 publications

References 54 publications

Variation in monitoring: Glucose measurement in the ICU as a case study to preempt spurious correlations

Variation in monitoring: Glucose measurement in the ICU as a case study to preempt spurious correlations

Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship

Risk and factors determining diabetes after mild, nonnecrotizing acute pancreatitis

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