Findings Challenge Tight Glucose Control for Critically Ill Patients

Tuesday, August 26, 2008; 6:00 PM

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TUESDAY, Aug. 26 (HealthDay News) -- Tight glucose control doesn't significantly reduce the risk of in-hospital death among critically ill patients. But, it is associated with an increased risk of hypoglycemia (abnormally low blood sugar), according to a study that challenges the common practice of tight glucose control for this group of patients.

Currently, many major medical organizations advise tight glucose control for critically ill patients, and these recommendations have been adopted in many intensive care units around the world, according to background information in the review study by U.S. researchers.

They analyzed data from 8,432 patients in 29 previous studies and found no significant difference in hospital death rates for patients on tight glucose control (21.6 percent) and those receiving usual care (23.3 percent).

The researchers also found that tight glucose control was not associated with a significantly decreased risk for new need for dialysis (11.2 percent vs. 12.1 percent), but was associated with a significantly decreased risk (10.9 percent vs. 13.4 percent) of septicemia (generalized illness due to bacteria in the blood).

However, patients on tight glucose control had about a five-fold increased risk of hypoglycemia (13.7 percent vs. 2.5 percent).

"Given the overall findings of this meta-analysis, it seems appropriate that the guidelines recommending tight glucose control in all critically ill patients should be re-evaluated until the results of larger, more definitive clinical trials are available," concluded Dr. Renda Soylemez Wiener, of the Department of Veterans Affairs Medical Center in White River Junction, Vt., and Dartmouth Medical School, in Hanover, N.H., and colleagues.

The study was published in the Aug. 27 issue of the Journal of the American Medical Association.

But, Simon Finfer, of the George Institute for International Health, and Anthony Delaney, of the Royal North Shore Hospital in Sydney, Australia, wrote in an accompanying editorial that it's possible that some of the studies included in the meta-analysis were flawed or that the meta-analysis itself was flawed.