Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

Mahmoodpoor, Ata; Hamishehkar, Hadi; Shadvar, Kamran; Beigmohammadi, Mohammad‐Taghi; Iranpour, Afshin; Sanaie, Sarvin

doi:10.4103/0972-5229.175938

Cited by 16 publications

(14 citation statements)

References 30 publications

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“…1 Previous studies have demonstrated that hyperglycemia, hypoglycemia, and glucose variability are independent risk factors for mortality of dysglycemic patients in intensive care settings. [2][3][4] Strict glycemic control is a time-consuming procedure and increases nursing workload and costs. 5 Although there is controversy on setting a target for blood glucose (BG) levels, intravenous infusion of regular short-acting insulin is the preferred approach for controlling serum glucose in intensive care units (ICUs).…”

Section: Introductionmentioning

confidence: 99%

<p>Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study</p>

Nader¹,

Hamishehkar²,

A³

et al. 2020

DMSO

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Objective: We aimed to examine the effects of adding a longer-acting insulin glargine to existing glucose control on reducing blood-glucose fluctuations in an intensive care unit (ICU). Methods: A total of 110 patients randomly received adjuvant insulin glargine 15 IU/day (glargine) or placebo (control), in addition to daily infusion of insulin to maintain glucose levels at a target of 140-180 mg/dL. End points were mean and variance of blood glucose and frequency of hypoglycemia, hyperglycemia, ICU stay, and mortality. Data were analyzed with repeated-measures ANOVA and Mann-Whitney U test. Results: Average daily glucose level was significantly less in the glargine group than controls (P<0.0001), while there was no difference in daily variance in blood glucose between the two groups. The duration of glucose concentrations being within the target range was identical between the glargine and control groups (16.6±4.9 vs 16.4±4.6 hours/ day, P=0.844) during the 7 days of admission. The frequency of hypoglycemia was greater in the glargine group and total duration of hyperglycemia (>180 mg/dL) much longer among controls (P<0.001). Similar mortality rates were observed in both groups, while ICU length of stay was 2 days shorter in the glargine group. Conclusion: Addition of insulin glargine to routine protocols more effectively reduces glucose levels and decreases incidence of hyperglycemic episodes and regular insulin usage. This adjustment may be associated with decreases in duration of ICU stay or increases in hypoglycemic events.

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Section: Introductionmentioning

confidence: 99%

<p>Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study</p>

Nader¹,

Hamishehkar²,

A³

et al. 2020

DMSO

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“…Finally, the era of 'one size fits all' in regard to glycemic targets in the critically ill seems to be over. We should also consider the correct and earlier diagnosis of patients, their glycemic status and preadmission glycemic control individually (6). Future trials should consider the discrepancies accounting for controversial points like nutritional status of patients, glucose monitoring methods (7) and insulin titration method.…”

Section: Original Articlementioning

confidence: 99%

Dysglycemia in Critically Ill Patients: Common Problems and Future Direction

Sanaie

Mahmoodpoor

2017

ABCMed

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The management of blood glucose (BG) in the critically ill became a topic of great interest following the publication of the landmark single-center surgical ICU study targeting euglycemia (80 to 110 mg/dL) in Leuven, Belgium, in 2001 (1). This study resulted in thousands of protocols and guidelines promoting 'tight' BG control . The failure to show the same results and high incidence of hypoglycemia in following trials have resulted in controversy in blood glucose management in critically ill patients. Analysis of dysglycemia in critically ill patients should include markers of three domains: hyperglycemia, hypoglycemia, and glycemic variability (2,3). Thus, hyperglycemia, hypoglycemia, and blood glucose variability should all be regarded as independent predictors of adverse outcomes in critically ill patients. Agus et al., in their multicenter study (4), showed that critically ill children with hyperglycemia did not benefit from strict glycemic control to a target glucose of 80-110 mg/dL compared to 150-180 mg/dL and patients in lower treatment target showed an insignificant 90-day mortally rate compared to other group. There are so many reasons to describe these controversies: In LEUVEN III study (5), despite a 25% hypoglycemia incidence, tight glycemic control had a significant treatment effect; nevertheless, in Agus et al. study, despite a lower incidence of hypoglycemia, treatment effect was not significant. The reasons can be explained with the fact that first trials were single centered open label studies which were terminated at early stages of the study because of observed benefits which may have exaggerated the treatment effect. Also, the observed difference was found in subgroup analysis which could have been due to chance factor. Findings from RCTs conducted on critically ill adults and children strongly suggest that the largest benefit for blood glucose control can be expected if the difference in blood glucose concentrations between the study groups is large and if the study is done in a single-centre setting where the blood glucose management is tailored to the local treatment habits. Consequently, we could not compare those single centered trials which are not externally validated with high level of adherence to protocols, lower time to target range, higher time in target range with multi centered trials with a low level of adherence to protocol higher time to target range, lower time in target range and a totally different method of energy supplementation. Finally, the era of 'one size fits all' in regard to glycemic targets in the critically ill seems to be over. We should also consider the correct and earlier diagnosis of patients, their glycemic status and preadmission glycemic control individually (6). Future trials should consider the discrepancies accounting for controversial points like nutritional status of patients, glucose monitoring methods (7) and insulin titration method.

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“…[7] Although glucose control is very important in treatment of critically ill patients, glucose measurement has some challenges. [89] Detection of signs and symptoms of hypoglycemia are difficult in critically ill patients, so repeated and accurate measurement has high priority. There are two types of blood glucose measurement in Intensive Care Unit (ICU); central laboratory and point-of-care (POC) glucometers.…”

Section: Introductionmentioning

confidence: 99%

Validity of bedside blood glucose measurement in critically ill patients with intensive insulin therapy

Mahmoodpoor

Hamishehkar

Shadvar

et al. 2016

Indian Journal of Critical Care Medicine

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Background and Aims:There have been variable results on the practice of tight glycemic control, and studies have demonstrated that point-of-care (POC) glucometers have variable accuracy. Glucometers must be accurate, and many variables can affect blood glucose levels. The purpose of this study was to determine the difference between blood glucose concentrations obtained from POC glucometers and laboratory results in critically ill patients with intensive insulin therapy.Materials and Methods:This was a descriptive study which enrolled 300 critically ill patients. Four samples of arterial blood were collected and analyzed at the bedside with the POC glucometer and also in the central laboratory to obtain the blood glucose level. To define the effect of various factors on this relation, we noted the levels of hemoglobin (Hb), PaO2, body temperature, bilirubin, history of drug usage, and sepsis.Results:There were not any significant differences between blood sugar levels using laboratory and glucometer methods of measurements. There was a good and significant correlation between glucose levels between two methods (r = 0.81, P < 0.001). Among evaluated factors (body temperature, bilirubin level, blood pressure, Hb level, PaO2, sepsis, and drugs) which added one by one in model, just drugs decreased the correlation more than others (r = 0.78).Conclusions:The results of POC glucometer differ from laboratory glucose concentrations, especially in critically ill patients with unstable hemodynamic status while receiving several drugs. This may raise the concern about using POC devices for tight glycemic control in critically ill patients. These results should be interpreted with caution because of the large variation of accuracy among different glucometer devices.

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Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

Cited by 16 publications

References 30 publications

<p>Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study</p>

<p>Effect of Adding Insulin Glargine on Glycemic Control in Critically Ill Patients Admitted to Intensive Care Units: A Prospective Randomized Controlled Study</p>

Dysglycemia in Critically Ill Patients: Common Problems and Future Direction

Validity of bedside blood glucose measurement in critically ill patients with intensive insulin therapy

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