No Benefit for Tight Glycemic Control in Critically Ill Children
(HealthDay News) – Tight glycemic control in critically ill children using intravenous insulin results in similar clinical outcomes as conventional glycemic control, but with a higher risk of hypoglycemia, according to a study published in the Jan. 9 issue of the New England Journal of Medicine.
Duncan Macrae, MB, ChB, from the Royal Brompton and Harefield NHS Foundation Trust in London, and colleagues selected 1,369 children (≤16 years) in the pediatric intensive care unit who were expected to require mechanical ventilation and vasoactive drugs for ≥12 hours. The patients were randomly assigned to tight glycemic control (blood glucose 72–126mg per deciliter) or conventional glycemic control (blood glucose <216mg per deciliter).
The researchers found that, at 30 days, the mean difference in the number of days alive and free from mechanical ventilation between groups was a statistically insignificant 0.36 days (95% confidence interval [CI], −0.42–1.14). However, there was a significantly higher likelihood of hypoglycemia (blood glucose <36 mg per deciliter) in the tight-glycemic-control group (7.3% vs. 1.5%; P<0.001). The mean 12 month costs were similar in both groups and in the 60% of patients who had undergone cardiac surgery, but were a mean of $13,120 lower in the tight-glycemic-control group among patients who had not undergone cardiac surgery (95% CI, −$24,682 to −$1,559).
"This multicenter, randomized trial showed that tight glycemic control in critically ill children had no significant effect on major clinical outcomes, although the incidence of hypoglycemia was higher with tight glucose control than with conventional glucose control," Macrae and colleagues conclude.