The optimal target for acute glycemic control in critically ill patients: a network meta-analysis

Yatabe, Tomoaki; Inoue, Shigeaki; Sakaguchi, Masahiko; Egi, Moritoki

doi:10.1007/s00134-016-4558-2

Cited by 72 publications

(64 citation statements)

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“…To provide more evidence with regard to the optimal blood glucose target in intensive care, Yatabe et al performed a network meta-analysis including RCTs that compared two different blood glucose targets in adult critically ill patients (14). In contrast to classic pair-wise meta-analyses, network meta-analyses are able to compare more than two treatments for a given condition (15).…”

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confidence: 99%

“…In addition, by combining results from direct comparisons and by using a common comparator, it can also indirectly estimate a difference between two treatments for which no-or only limited -head-to-head comparisons exist. Hence, Yatabe et al categorized the study arms from the included RCTs into four different treatment categories, going from tight blood glucose control (<110 mg/dL), over intermediate (110-144 and 144-180 mg/dL) to liberal blood glucose control (>180 mg/dL) (14). In network metaanalysis, there was no significant difference in the risk of hospital mortality or infections between all comparisons.…”

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confidence: 99%

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Blood glucose control in the ICU: how tight?

Gunst¹,

Berghe²

2017

Ann. Transl. Med.

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confidence: 99%

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confidence: 99%

Blood glucose control in the ICU: how tight?

Gunst¹,

Berghe²

2017

Ann. Transl. Med.

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“…Tight glycaemic control of critically ill patients has no effect on mortality but causes five times as much hypoglycaemia compared to mild or very mild control [33, 34]. Ways have to be found to limit hypoglycaemia occurrence, such as minimising infusion volume and monitoring glucose levels.…”

Section: Discussionmentioning

confidence: 99%

Effect of insulin infusion line on glycaemic variability in a perioperative high dependency unit (HDU): a prospective randomised controlled trial

Genay

Décaudin

Ethgen

et al. 2017

Ann. Intensive Care

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BackgroundGlucose control is an important issue in post-operative patients. The objective here was to compare two insulin infusion lines by syringe pumps to assess the impact of medical devices on glycaemic variability in surgical patients under intensive insulin therapy. This open, prospective, single-centre randomised study was conducted in a fifteen-bed perioperative high dependency unit (HDU) in a university hospital. In total, 172 eligible patients receiving insulin therapy agreed to participate in the study. Subcutaneous continuous glucose monitoring was set up for all patients and an optimised system with a dedicated insulin infusion line for half of the patients.ResultsEighty-six patients were infused via the optimised infusion line and 86 patients via the standard infusion line. No significant difference was found according to the glycaemic lability index score [mean difference between groups (95% CI): −0.09 (−0.34; 0.16), p = 0.49 after multiple imputation]. A glucose control monitoring system indicated a trend towards differences in the duration of hypoglycaemia (blood glucose level below 70 mg dl−1 (3.9 mmol l−1) over 1000 h of insulin infusion (9.7 ± 25.0 h in the standard group versus 4.4 ± 14.8 h in the optimised group, p = 0.059) and in the number of patients experiencing at least one hypoglycaemia incident (25.7 vs. 12.9%, p = 0.052). Time in the target range was similar for both groups.ConclusionsThe use of optimised infusion line with a dedicated insulin infusion line did not reduce glycaemic variability but minimised the incidence of hypoglycaemia events. The choice of the medical devices used to infuse insulin seems important for improving the safety of insulin infusion in perioperative HDU.

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“…It was later shown by several studies, including the NICE-SUGER study, that intensive glucose control increased hypoglycemic events and mortality, and that a blood glucose target of 180 mg/dL resulted in better outcomes compared to lower targets [51][52][53]. According to current data, no specific glucose concentration range below the value of 180 mg/dL has further mortality benefits [54]. Variability in blood glucose concentrations is also known to be an important prognostic factor.…”

Section: Glucose Controlmentioning

confidence: 99%

Advances in Medical Nutrition Therapy: Parenteral Nutrition

Itzhaki

Singer

2020

Nutrients

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Parenteral nutrition has evolved tremendously, with parenteral formulas now safer and more accessible than ever. "All-in-one" admixtures are now available, which simplify parenteral nutrition usage and decrease line infection rates alongside other methods of infectious control. Recently published data on the benefits of parenteral nutrition versus enteral nutrition together with the widespread use of indirect calorimetry solve many safety issues that have emerged over the years. All these advances, alongside a better understanding of glycemic control and lipid and protein formulation improvements, make parenteral nutrition a safe alternative to enteral nutrition.

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The optimal target for acute glycemic control in critically ill patients: a network meta-analysis

Cited by 72 publications

References 50 publications

Blood glucose control in the ICU: how tight?

Blood glucose control in the ICU: how tight?

Effect of insulin infusion line on glycaemic variability in a perioperative high dependency unit (HDU): a prospective randomised controlled trial

Advances in Medical Nutrition Therapy: Parenteral Nutrition

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