ArticleChest2013
Moderate glucose control is associated with increased mortality compared with tight glucose control in critically ill patients without diabetes.
Article in Chest, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 70 citations in OpenAlex.
- Insulin-Based Infusion System: Preliminary Study.Journal of diabetes science and technology · 2019Trial
- Perioperative Glycemic Control and Outcomes in Cardiac Surgery: A Retrospective Cohort Study.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records.European journal of medical research · 2024Observational
- Article
- Inpatient hyperglycaemia, and impact on morbidity, mortality and re-hospitalisation rates.Clinical medicine (London, England) · 2022Article
- Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study.Acta diabetologica · 2022Article
- The stress hyperglycemia ratio, a novel index of relative hyperglycemia, predicts short-term mortality in critically ill patients after esophagectomy.Journal of gastrointestinal oncology · 2022Article
- Glycemic targets in critically ill adults: A mini-review.World journal of diabetes · 2021Review
- Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Time in blood glucose range 70 to 180 mg/dL and survival rate in critically ill patients: A retrospective cohort study.PloS one · 2021Article
- Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses.Journal of inflammation research · 2020Article
- The Long and Winding Road Toward Personalized Glycemic Control in the Critically Ill.Journal of diabetes science and technology · 2018Review
- Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data.Cardiovascular diabetology · 2017Article
- Hypoglycemia Reduction Strategies in the ICU.Current diabetes reports · 2017Review
- Continuous glucose monitoring in the ICU: clinical considerations and consensus.Critical care (London, England) · 2017Review
- Glucose Control in the ICU: A Continuing Story.Journal of diabetes science and technology · 2016Review
- Glucose management in the intensive care unit: are we looking for the right sweet spot?Annals of translational medicine · 2016Article
- Admission hyperglycemia in sepsis is associated with poor outcomes: where do we go from here?Journal of thoracic disease · 2016Article
- Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality.Intensive care medicine · 2016Observational
- Population-Specific Models of Glycemic Control in Intensive Care: Towards a Simulation-Based Methodology for Protocol Optimization.Proceedings of the ... American Control Conference. American Control Conference · 2015Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundOptimal glucose management in the ICU remains unclear. In 2009, many clinicians at Intermountain Healthcare selected a moderate glucose control (90-140 mg/dL) instead of tight glucose control (80-110 mg/dL). We hypothesized that moderate glucose control would affect patients with and without preexisting diabetes differently.
methodsWe performed a retrospective cohort analysis of all patients treated with eProtocol-insulin from November 2006 to March 2011, stratifying for diabetes. We performed multivariate logistic regression for 30-day mortality with covariates of age, modified APACHE (Acute Physiology and Chronic Health Evaluation) II score, Charlson Comorbidity score, and target glucose.
resultsWe studied 3,529 patients in 12 different ICUs in eight different hospitals. Patients with diabetes had higher mean glucose (132 mg/dL vs 124 mg/dL) and greater glycemic variability (SD = 41 mg/dL vs 29 mg/dL) than did patients without diabetes (P < .01 for both comparisons). Tight glucose control was associated with increased frequency of moderate and severe hypoglycemia (30.3% and 3.6%) compared with moderate glucose control (14.3% and 2.0%, P < .01 for both). Multivariate analysis demonstrated that the moderate glucose target was independently associated with increased risk of mortality in patients without diabetes (OR, 1.36; 95% CI, 1.01-1.84; P = .05) but decreased risk of mortality in patients with diabetes (OR, 0.65; 95% CI, 0.45-0.93; P = .01).
conclusionsModerate glucose control (90-140 mg/dL) may confer greater mortality in critically ill patients without diabetes compared with tight glucose control (80-110 mg/dL). A single glucose target does not appear optimal for all critically ill patients. These data have important implications for the design of future interventional trials as well as for the glycemic management of critically ill patients.
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