Hypoglycemia and Outcome in Critically Ill Patients

Abstract

In critically ill patients, an association exists between even mild or moderate hypoglycemia and mortality. Even after adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death.

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

“…Use of insulin has been shown to increase glucose tolerance [22][23][24][25][26][27], resulting in increased weight gain [23,25,27], but also commonly results in increased incidence of hypoglycaemia (low blood glucose concentration) [28][29][30], which is also dangerous. In adult intensive care even a single hypoglycaemic episode has been associated with increased risk of mortality [31][32][33], while in neonatal intensive care hypoglycaemia as been associated with adverse neurological outcomes [34,35]. Model-based methods for glycaemic control have been little investigated, due in part to the extremely fragile nature of this cohort and the subsequent limitations on invasive procedures and blood sample collection [36] that thus also limit the ability to identify parameters to validate more physiologically relevant and complex models.…”

First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients

“…An example is illustrated on the right panel in Figure 8. The stochastic insulin model can then be used to forecast likely blood glucose outcomes for a given intervention (a given insulin infusion), using the model defined by Equations (1) to (3). This approach, illustrated in Figure 9, allows the optimization of prediction and ensures safety, especially from hypoglycemia.…”

“…Hyperglycemia worsens outcomes and increases mortality [1][2][3][4]. Effective glycemic control should reduce blood glucose (BG) levels, reduce variability and account for inter-and intrapatient variability and evolving physiological patient condition [5][6][7].…”

“…Hypoglycemia is a major risk associated with TGC [3,14,15]. Limiting hypoglycemia and ensuring safety is critical for any TGC protocol.…”

Virtual Trials of the NICE-SUGAR Protocol: The Impact on Performance of Protocol and Protocol Compliance

“…One explanation for these conflicting results is the role of increased hypoglycaemia and BG variability in confounding results (Bagshaw et al, 2009, Egi et al, 2010, Krinsley and Preiser, 2015. In order to adequately test the improved outcome hypothesis, insulin therapy must be carried out in a safe and effective manner, and be consistently achieved for all or nearly all patients (Chase et al, 2010a).…”