Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients

Saliba, Lina; Cook, Charles H.; Dungan, Kathleen; Porter, Kyle; Murphy, Claire V.

doi:10.1016/j.jcrc.2016.06.010

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…Some investigators suggest that iatrogenic hypoglycemia is not associated with increased mortality, 35,36 whereas others suggest that hypoglycemia is harmful regardless of whether it is spontaneous or iatrogenic. 37 Regardless, avoidance of iatrogenic hypoglycemia has been a central explanation for the purported benefit of moderate glucose control. We observed extremely low rates of severe hypoglycemia (< 40 mg/dL), which is lower than what has been observed in many of the other intensive insulin therapy studies.…”

Section: Discussionmentioning

confidence: 99%

Percentage of Time in Range 70 to 139 mg/dL Is Associated With Reduced Mortality Among Critically Ill Patients Receiving IV Insulin Infusion

Lanspa

Krinsley

Hersh

et al. 2019

Chest

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BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, reduced time in targeted blood glucose range (TIR) is associated with increased risk of death in critically ill patients. This relation between TIR and mortality may be confounded by diabetic status and antecedent glycemic control. METHODS: This study retrospectively analyzed critically ill patients managed with the same IV insulin protocol at multiple centers. The percentage of TIR between 70 and 139 mg/dL was calculated. Patients with diabetic ketoacidosis, patients who had < 10 blood glucose readings, and patients with repeat admissions were excluded. The highest recorded glycosylated hemoglobin value in the preceding 3 months or up to 1 month following admission were used as a surrogate for the patient's preexisting glucose control. Stratified regression analyses were performed for 30-day mortality, with covariates of age, sex, TIR $ 80%, Acute Physiology Score, and Charlson Comorbidity Index. RESULTS: A total of 9,028 patients, 53.2% of whom had diabetes, were studied. Median TIR was 84.1% for nondiabetic patients and 64.5% for patients with diabetes. Mortality was lower in those with TIR > 80% compared with those with TIR # 80% (12.4% vs 19.2%; P < .001). TIR > 80% was independently associated with reduced mortality in nondiabetic patients (OR, 0.52; P < .001), patients with diabetes (OR, 0.69; P ¼ .001), and patients with wellcontrolled disease (OR, 0.50; P < .001) but not in patients with poorly controlled disease (OR, 0.86; P ¼ .40). CONCLUSIONS: TIR was independently associated with mortality in critically ill patients, particularly those with good antecedent glucose control.

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Section: Discussionmentioning

confidence: 99%

Percentage of Time in Range 70 to 139 mg/dL Is Associated With Reduced Mortality Among Critically Ill Patients Receiving IV Insulin Infusion

Lanspa

Krinsley

Hersh

et al. 2019

Chest

View full text Add to dashboard Cite

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“…[ 2 ] In addition, more than half of the respondents defined hypoglycemia as a BG level of <3.0 mmol/L, although BG ≤3.9 mmol/L was associated with increased hospital mortality in critically ill patients. [ 4 ] Most of the respondents generally administered 40 ml 50% dextrose to treat hypoglycemia; however, few respondents remeasured BG levels in 15 min, therefore the risk of iatrogenic hyperglycemia may increase. [ 2 ]…”

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confidence: 99%

Attitudes, Knowledge, and Practices Regarding Blood Glucose Control

Liu

Wang

Liu

et al. 2018

Chinese Medical Journal

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“…20 Patients with the abovementioned factors need to be identified as being at high risk for hypoglycemia and associated poor outcomes that perhaps require closer monitoring in the ICU to avoid the adverse risks of hypoglycemia. While initially, the evidence pointed to spontaneous hypoglycemia 28 in the ICU predicting worse outcomes in patients with advanced illness like adrenal insufficiency, renal failure, and liver failure, newer studies are starting to recognize iatrogenic or medication-induced hypoglycemia to be equally hazardous in the critically ill. 29 The mechanisms by which hypoglycemia causes worsened clinical outcomes are not entirely clear. The neurons utilize glucose as an obligatory metabolic fuel, and at extreme hypoglycemia, in addition to a state of energy failure, profound and prolonged hypoglycemia is also associated with release of excitatory neurotransmitters that cause neuronal cell damage and death.…”

Section: Hypoglycemiamentioning

confidence: 99%

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

Tickoo

2019

Semin Respir Crit Care Med

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In the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

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Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients

Cited by 18 publications

References 19 publications

Percentage of Time in Range 70 to 139 mg/dL Is Associated With Reduced Mortality Among Critically Ill Patients Receiving IV Insulin Infusion

Percentage of Time in Range 70 to 139 mg/dL Is Associated With Reduced Mortality Among Critically Ill Patients Receiving IV Insulin Infusion

Attitudes, Knowledge, and Practices Regarding Blood Glucose Control

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

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