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

Abstract

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.

<p>Association Between Blood Glucose Within 24 Hours After Intensive Care Unit Admission and Prognosis: A Retrospective Cohort Study</p>

“…5,6 Hyperglycemia was once considered an adaptive response essential for survival and therefore not routinely controlled, 7 but numerous observational studies have provided evidences which supported a link between hyperglycemia and poor prognosis of critically ill patients. 2,[8][9][10][11][12][13][14][15] Now it is well accepted that glycemic control plays an important role in the management of patients in ICU, 16 but it is still controversial what the optimal blood glucose range is. 17,18 Evidences from several clinical trials which investigated various ranges of blood glucose in various populations of ICU patients supported different target blood glucose, and are sometimes contrary.…”

“…include study populations under specific and strict criteria, of which the characteristics may be quite different to the general population, and that the clinical practice and patient characteristics in ICU are usually highly heterogeneous, evidences from real-world clinical data might provide some clues for trials which aim at determining or validating the ideal target of glycemic control, [22][23][24] although it is obvious that what the ideal target of glycemic control could only be answered by clinical trials. Given current available observational studies had either limited sample sizes 10 or specific indications, 12,14 the study used data from a large critical care database and focused on mixed ICU patients, aiming to evaluate the association between blood glucose within 24 hours after ICU admission and prognosis.…”

Hyperglycemia management in hospitalized patients with COVID-19

“…3,4 For these reasons, a glucose target of 140 to 180 mg/dL is reasonable in most critically ill patients. 5,6 ■ COVID-19 AND HYPERGLYCEMIA As of this writing (April 9, 2020), the COVID-19 pandemic has infected more than 1.5 million people worldwide and more than 400,000 in the United States, and these numbers are projected to increase. 6 This increase will come with a high death toll, increased morbidity rates, and an expected surge in the number of critically ill patients.…”

Advances in Medical Nutrition Therapy: Parenteral Nutrition

“…Several studies demonstrated in heterogeneous populations of critically ill patients that increased glucose variability increased ICU and hospital mortality independently of the mean glucose concentration [55][56][57]. In recent years, the concept of time regarding glucose ranges proved to be of significant importance, with patients with normal blood glucose levels more than 80% of the time showing better outcomes [58][59][60]. Patients with or without diabetes may be affected differently by glucose concentrations [61].…”