Mild hypoglycemia is independently associated with increased mortality in the critically ill

Krinsley, James S.; Schultz, MS; Spronk, Peter E.; Harmsen, Robin E.; Houckgeest, F Van Braam; Sluijs, JP Van der; Mélot, Christian; Preiser, J.-C.

doi:10.1186/cc9817

Cited by 31 publications

(36 citation statements)

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“…Patients with minimum BG during ICU stay 54-63 mg/dL had a nearly twofold increase in the odds of death compared with those with minimum BG 72-81 mg/dL. These findings were confirmed 1 year later in a study that included data from 6240 patients treated at the Academic Medical Center (The Netherlands), Stamford Hospital (the USA) and participating in the Glucontrol RCT of IIT [19]. …”

Section: Three Domains Of Glycemic Controlsupporting

confidence: 63%

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Glycemic control in the critically ill: What have we learned since NICE-SUGAR?

Krinsley

2015

Hospital Practice

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Since publication of the Normoglycemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation trial in 2009, demonstrating increased 90-day mortality in a large cohort of critically ill patients treated with the intensive, rather than moderate blood glucose (BG) target, enthusiasm has dampened for 'tight glucose control' in intensive care units. Nevertheless, a burgeoning literature has clarified limitations of the interventional trials of intensive insulin therapy in the critically ill and explored key clinical aspects of glycemic control in this population. This review provides an overview of the last 6 years of research in this field. Topics include advances in understanding the domains of glycemic control - hyperglycemia, hypoglycemia and glucose variability; the role of diabetic status in modulating the relationship of these domains of control to mortality; the importance of premorbid glucose control in patients with diabetes; the central role that measurement frequency has in determining success in achieving desired BG control and, finally, new data exploring time in targeted BG range, a potentially 'unifying' metric.

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Section: Three Domains Of Glycemic Controlsupporting

confidence: 63%

“…Mean (SD) AM GG (mg/dL) Time in range a Leuven 1 [1] 103 (19) 53.1% Leuven 2 [2] 111 (29) 35.5% VISEP [3] 112 (18) 45.4% Glucontrol [4] 110 (99-124) b 42.8% c NICE-SUGAR [7] 118 ( [54]. This is the only investigation that has stratified TIR by diabetic status.…”

Section: Studymentioning

confidence: 99%

Glycemic control in the critically ill: What have we learned since NICE-SUGAR?

Krinsley

2015

Hospital Practice

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“…Furthermore, patients with more severe degrees of hypoglycemia sustained higher ICU and hospital mortality (85,86). A greater risk of mortality (RR 2.18, 95% CI [1.87, 2.53]; p < .0001) was similarly reported with mild to moderate hypoglycemia (BG 55-69 mg/dL) in a post hoc analysis of prospective data collected in a randomized trial and two large cohorts (87). These data confirmed the results of another cohort study that demonstrated that mild-moderate hypoglycemia, BG 54-63 mg/dL, was independently associated with increased risk of mortality (85).…”

Section: What Is the Impact Of Hypoglycemia In The General Icu Populasupporting

confidence: 54%

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

Jacobi

Bircher

Krinsley

et al. 2012

Critical Care Medicine

489

414

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“…In two large clinical studies, a brief episode of severe hypoglycemia below 2.2 mmol/l did not cause early deaths, coincided with only minor immediate and transient morbidity in a minority of patients, and did not lead to late neurological sequellae among hospital survivors [40]. Nevertheless, apart from hyperglycemia also hypoglycemia has been associated with an increased risk of ICU or in-hospital death in a dose-response relationship, even when mild, with greater risk the lower the glucose levels fall [41][42][43]. Hypoglycemia has been associated with lower performance in one domain of a full range of cognitive functions (visuospatial skills) at least 1 year after critical illness in adult patients, but hyperglycemia and glycemic fluctuations were as well and hence could not be excluded as confounders [44].…”

Section: Hypoglycemiamentioning

confidence: 99%