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SCCM: Tight Glycemic Control No Benefit in Peds Hyperglycemia

Low likelihood of benefit, evidence of possibility of harm in critically ill children with hyperglycemia

a child girl patient

WEDNESDAY, Jan. 25, 2017 (HealthDay News) -- For critically ill children with hyperglycemia, tight glycemic control is not beneficial, according to a study published online Jan. 24 in the New England Journal of Medicine to coincide with the annual Society of Critical Medicine's Critical Care Congress, held from Jan 21 to 25, Honolulu.

Michael S.D. Agus, M.D., from the Boston Children's Hospital, and colleagues conducted a 35-center trial involving critically ill children with confirmed hyperglycemia. Participants were randomized to lower- or higher-target glycemic control: 80 to 110 mg/dL or 150 to 180 mg/dL (360 and 353 patients, respectively).

On the recommendation of the data and safety monitoring board, the trial was stopped early owing to low likelihood of benefit and evidence of the possibility of harm. The researchers found that the median number of intensive care unit (ICU)-free days did not differ between the lower- and higher-target groups (19.4 versus 19.4 days; P = 0.58), in the intention-to-treat analysis. The median time-weighted average glucose level was significantly lower in the lower-target group in per-protocol analyses (109 versus 123 mg/dL; P < 0.001). The rates of health care-associated infection were higher for patients in the lower-target group (3.4 versus 1.1 percent; P = 0.04).

"Critically ill children with hyperglycemia did not benefit from tight glycemic control targeted to a blood glucose level of 80 to 110 mg per deciliter, as compared with a level of 150 to 180 mg per deciliter," the authors write.

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