June 21, 2017

CT researcher: Glucose management key in ICU transitions

Monitoring and maintaining glucose levels of critically ill patients from ICU to general care through hospital discharge may positively impact patient outcomes, according to findings of research led by a Stamford Hospital doctor.

"Our research suggests that the glucose blood level of critical patients transferred back to general care matters – specifically control of dysglycemia (hyper, hypo and glucose variability) – which were all independently associated with mortality in patients without diabetes," Dr. James Krinsley, director of critical care at the hospital and clinical professor of medicine at Columbia University College of Physicians, said in a statement. "The data also suggests that patients should have blood glucose targets based on their personal characteristics rather than a 'one-size-fits-all' approach as current guidelines state."

The findings will be published in the July 7 issue of the journal Mayo Clinic Proceedings. The article supports the importance of glucose control throughout the period of care for critically ill patients – and suggests that the current blood glucose targets range may not be appropriate for patients without diabetes, according to Stamford Health.

Krinsley collaborated with Dr. Stanley Nasraway, director of the surgical ICU and professor at Tufts University School of Medicine in Boston and five others on a retrospective investigation of the relationship between mean blood glucose, hypoglycemia, high glucose variability, diabetes and mortality among nearly 6,400 ICU patients with five or more blood glucose tests and nearly 4,500 ICU survivors admitted at two academic medical centers between July 2010 and December 2014.

Their investigation and other literature suggests that for people without diabetes, a target glucose level of 80-140 mg/dL is strongly associated with best prospects for survival, Krinsley said.

"We believe this study is the first to report on the association of glucose control with mortality in a cohort of critically ill patients spanning the entire continuum of hospitalization," he said.

However, there was no clear relationship between blood glucose level and mortality for patients with diabetes in the ICU or the floor.

The next step would be to institute randomized controlled trials to see if protocols for glucose control instituted in general care floors lead to better outcomes, Stamford Health said.

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