OR49-3 Improved Mortality with Tight Glycemic control in critically ill patient's - A retrospective analysis in a large Hospital system

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR49-Insulin Therapy: Glycemic Control & Hypoglycemia
Clinical
Tuesday, June 18, 2013: 9:15 AM-10:45 AM
Presentation Start Time: 9:45 AM
Room 307 (Moscone Center)
Renu Joshi*1, Sachin Patel2, Yijin Wert2, Arvin Parvathaneni2, Pramil Cheriyath2 and Anix Vyas2
1Pinnacle Health System, MECHANICSBURG, PA, 2Pinnacle health system
BACKGROUND:

The efficacy of tight glycemic control among the critically ill patients in reducing the mortality rate and length of stay has been controversial. Based on the available evidence, the American College of Endocrinology (ACE) published a position statement in 2008 recommending relaxed glycemic control (BG <180mg/dl) for patients admitted to intensive care units (ICUs)(1). However, many hospitals still continue to practice tight glycemic control. We conducted a retrospective study identifying the impact of tight glucose control among ICU patients on mortality, average length of stay, and incidence of severe hypoglycemia in a large group of hospitalized patients at our multi-hospital, community-based and teaching health care system.

 

RESEARCH DESIGN AND METHOD:

The study population included patients admitted to MED-SURG ICU in a 634-bed health care system consisting of two acute care hospitals in central Pennsylvania from 2008-2012. A preprinted glycemic control protocol has been in place for 10 years. A total of 18,919 patients were identified. After excluding patients with less than four Blood Glucose (BG) readings, the population was grouped into three separate categories based on their average BG levels (80-110mg/dl, 110-140mg/dl, and 140-180mg/dl). The primary outcome of the study was mortality in the ICU. The secondary outcome included length of stay and one time episode of severe hypoglycemia of < 40 per patient. Statistical analysis was performed using SAS 9.3 software.

 

RESULTS:  

Patients in the group with average BG value of 80-110mg/dl and 110-140mg/dl had lower ICU mortality rates of 8.34% and 9.61 % respectively when compared to 12.94% in the group with BG value of 140-180 mg/dl. This difference was statistically significant (P<0.005). Furthermore, the average length of ICU stay was significantly lower at 2.91 days in patients with average BG 80-110 mg/dl when compared to the other two groups at 4.48 and 4.04 days (P Value < 0.05). The episode of severe hypoglycemia was slightly high in the tight control group at a rate of 4.77 % as compared to 3.36 and 3.47 % respectively in other 2 groups.

 

CONCLUSION:

 We found that tight glycemic control from 80-110 mg/dl is beneficial for ICU mortality rate and length of stay. These findings are different than previously published studies. Our study also found that episode of hypoglycemia is slightly higher in the tight control group but much lower compared to other published literature. (2)

1.Etie S. Moghissi, Mary T. Korytkowski, Monica DiNardo, Daniel Einhorn, Richard Hellman, Irl B. Hirsch, Silvio E. Inzucchi, Faramarz Ismail-Beigi, M. Sue Kirkman, Guillermo E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care. 2009 June; 32(6): 1119–1131. doi: 10.2337/dc09-9029 PMCID: PMC2681039 2Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hebert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ: Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009, 360:1346-1349

Nothing to Disclose: RJ, SP, YW, AP, PC, AV

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm