Variability of Blood Glucose Concentration and Short-term Mortality in Critically Ill Patients

Egi, Moritoki; Bellomo, Rinaldo; Stachowski, Edward; French, Craig; Hart, Graeme K

doi:10.1097/00000542-200608000-00006

Cited by 755 publications

(531 citation statements)

References 32 publications

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“…40 Marked fluctuations in blood glucose may be harmful, independent of the absolute mean glucose level. [41][42][43] There is no consistent definition of glycemic variability, and several metrics, e.g., the coefficient of variation of blood glucose levels or the glycemic lability index, have been used in critical illness. 41,44 It is also unclear whether variations within the normal glycemic range or periods of significant hypo-and hyperglycemia are problematic.…”

Section: Glucose Metabolismmentioning

confidence: 99%

Perioperative catabolism

Schricker

Lattermann

2015

Can J Anesth/J Can Anesth

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Section: Glucose Metabolismmentioning

confidence: 99%

Perioperative catabolism

Schricker

Lattermann

2015

Can J Anesth/J Can Anesth

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“…• Mortality increases with blood glucose variability, independent of mean or median value achieved by any form of glycemic control [60][61][62][63].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

“…Hence, the inability to manage variability with respect to relatively low blood glucose values on a per-patient or patient-specific basis may result in significant hypoglycemia. This more variable per-patient TGC can increase mortality, matching retrospective analyses [60][61][62][63].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

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Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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“…Lowering the blood glucose levels in critically ill patients with chronic hyperglycemia will result in drastic and rapid changes of glucose concentrations. The degree of blood glucose change (glycemic variability) has been demonstrated to be an independent predictor of poor outcome in critically ill patients [13]. In patients with type II diabetes, glycemic variability has been demonstrated to increase oxidative stress [14].…”

mentioning

confidence: 99%

Treatment thresholds for hyperglycemia in critically ill patients with and without diabetes

Marik

Egi

2014

Intensive Care Med

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Variability of Blood Glucose Concentration and Short-term Mortality in Critically Ill Patients

Abstract: The SD of glucose concentration is a significant independent predictor of intensive care unit and hospital mortality. Decreasing the variability of blood glucose concentration might be an important aspect of glucose management.

Cited by 755 publications

References 32 publications

Perioperative catabolism

Perioperative catabolism

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Treatment thresholds for hyperglycemia in critically ill patients with and without diabetes

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