Intensive insulin therapy versus glycemic control in critically ill patients: a prospective controlled trial

Azevedo, JR; Junior, LO Araujo; Azevedo, RP; Silva, WS; Cruz, F.J.M.R.

doi:10.1186/cc5869

Cited by 3 publications

(8 citation statements)

References 3 publications

(2 reference statements)

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“…Overall, 28 articles were excluded ( Figure 1). We included 26 trials [8][9][10][11][12][13]18,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] in the meta-analysis.…”

Section: Literature Searchmentioning

confidence: 99%

“…[22][23][24][26][27][28]31,34,37 One trial randomly assigned patients to 1 of 3 levels of glycemic control: 4.4-6.1 mmol/L, 6.7-8.3 mmol/L or 10.0-11.1 mmol/L. 29 Given our selection criteria of a target glucose level of 8.3 mmol/L or less, we combined data from the 2 intervention arms for our primary mortality analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[8][9][10][11][12][13]18,22,25,[31][32][33]35,36 The pooled RR was 6.0 (95% CI 4.5-8.0), with some evidence of heterogeneity between studies (Q statistic = 20.7, p = 0.08), with a corresponding I 2 statistic of 37% (95% CI 0%-67%). We were unable to examine the data for effect modification by intensity of insulin therapy because only 1 trial that reported severe hypoglycemia used a target blood glucose level of 8.3 mmol/L or less.…”

Section: Hypoglycemic Eventsmentioning

confidence: 99%

“…Mitchell et al 35 He et al 30 Azevedo et al 22 Arabi et al 10 McMullin et al 34 Wang et al 38 Yu et al 39 De La Rosa Gdel et al 12 Brunkhorst et al 11 NICE-SUGAR 18 Zhang et al 40 Devos et al 13 Mackenzie et al 33 Henderson et al 31 Iapichino et al 32 …”

Section: All Mixed Icu Patientsmentioning

confidence: 99%

“…44,45 In the surgical ICU subgroup, there were only 77 deaths in the intensive insulin therapy group and 110 in the usual care group. Overall NICE-SUGAR 18 Arabi et al 10 Mackenzie et al 33 Iapichino et al 32 Van den Berghe et al 8 De La Rosa Gdel et al 12 Oksanen et al 36 Van den Berghe et al 9 Azevedo et al 22 Devos et al 13 Brunkhorst et al 11 Henderson et al 31 Bland et al 25 Mitchell et al 35 5. A second possibility is that, because intensive insulin therapy is a complex treatment and the results may be dependent on the implementation of the intervention and the accuracy of blood glucose measurement, 46 these factors may have differed between Van den Berghe's first trial and subsequent trials.…”

Section: Studymentioning

confidence: 99%

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Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data

Griesdale¹,

Souza²,

Dam³

et al. 2009

Canadian Medical Association Journal

951

614

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Section: Literature Searchmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Hypoglycemic Eventsmentioning

confidence: 99%

Section: All Mixed Icu Patientsmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

See 3 more Smart Citations

Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data

Griesdale¹,

Souza²,

Dam³

et al. 2009

Canadian Medical Association Journal

951

614

View full text Add to dashboard Cite

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies

et al. 2023

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ObjectivesAnxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.MethodsThis is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.ResultsAccording to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.ConclusionAt least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

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Glycemic Control in the Medical Intensive Care Unit

Kovalaske

Gandhi

2009

J Diabetes Sci Technol

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Hyperglycemia in the critically ill is a well-known phenomenon, even in those without known diabetes. The stress response is due to a complex interplay between counter-regulatory hormones, cytokines, and changes in insulin sensitivity. Illness/infection, overfeeding, medications (e.g., corticosteroids), insufficient insulin, and/or volume depletion can be additional contributors. Acute hyperglycemia can adversely affect fluid balance (through glycosuria and dehydration), immune and endothelial function, inflammation, and outcome. While there are several insulin infusion protocols that are able to safely and effectively treat hyperglycemia, the bulk of accumulated evidence does not support a causal relationship between acute hyperglycemia and adverse outcomes in the medical intensive care unit. Meta-analysis of randomized controlled trials suggests there is no benefit to tightening glucose control to normal levels compared to a reasonable and achievable goal of 140 to 180 mg/dl. There is a significantly increased risk of hypoglycemia. Although there is some evidence that patients without known diabetes have worse outcomes than those with known diabetes, more recent evidence is conflicting. Glycemic control in critically ill patients should not be neglected, as studies have not tested tight versus no/poor control, but tight versus good control. A moderate approach to managing critical illness hyperglycemia seems most prudent at this juncture. Future research should ascertain whether there are certain subgroups of patients that would benefit from tighter glycemic goals. It also remains to be seen if tight glucose control is beneficial once hypoglycemia is minimized with technological advances such as continuous glucose monitoring systems.

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Intensive insulin therapy versus glycemic control in critically ill patients: a prospective controlled trial

Cited by 3 publications

References 3 publications

Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data

Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies

Glycemic Control in the Medical Intensive Care Unit

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