No Benefit for Tight Glycemic Control in Critically Ill Children

Risk of hypoglycemia higher in critically ill children with tight glycemic control

THURSDAY, Jan. 9, 2014 (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, M.B., Ch.B., from the Royal Brompton and Harefield NHS Foundation Trust in London, and colleagues selected 1,369 children (16 years and younger) in the pediatric intensive care unit who were expected to require mechanical ventilation and vasoactive drugs for at least 12 hours. The patients were randomly assigned to tight glycemic control (blood glucose 72 to 126 mg per deciliter) or conventional glycemic control (blood glucose <216 mg 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 percent confidence interval [CI], −0.42 to 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 versus 1.5 percent; P < 0.001). The mean 12 month costs were similar in both groups and in the 60 percent 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 percent 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.

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