Glycaemic Control and Mortality Outcomes in Intensive Care Unit

Abstract

Introduction: Hyperglycaemia is associated with adverse physiological outcome and high mortality rates in critically ill patients. Intensive Insulin Therapy (IIT) for glycaemic control often leads to hypoglycaemia and increases risk of death, therefore targeted glycaemic management in Intensive Care Unit (ICU) are need of the hour. Aim: To study whether achieving glycaemic control during stay in ICU can affect mortality rate in critically ill patients. Materials and Methods: The prospective observational study was conducted on 325 diabetic patients admitted in ICU at Yenepoya Medical College and Hospital, Karnataka. Upon admission to ICU, blood sugar and Glycated haemoglobin (HbA1c) levels were measured. Age, sex, duration of Diabetes Mellitus (DM), co-morbidities, Sequential organ failure assessment (SOFA) score, Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, hypoglycaemic episodes, and drug history were recorded. Following Conventional Insulin Therapy (CIT) and Intensive Insulin Therapy treatment, the mortality outcomes were documented. Independent student t-test was used to compare mean changes between two parameters and ANOVA was used for comparison of changes between the groups in quantitative variables. Chi-square test was used for analysing qualitative variables between groups. A twosided p<0.05 was considered as statistically significant value. Results: The patient’s population was predominantly men 210 (64.6%), 190 (57%) were older than 60 years. ICU mortality was 110 (33.8%). 56.1% of patients received IIT and 43.1% of patients received CIT. Mortality in IIT was 75 (22.8%) and mortality in CIT was 250 (77.2%). Mortality was significantly lower (p<0.05) in the IIT group than in the CIT group. Conclusion: The results of the present research supports implementation of IIT in intensively ill patients of ICU. IIT in critically ill patients was associated with an overall reduction in morbidity and mortality. The present study’s results together with data from latest studies, suggest a need for the broad implementation of IIT and a rising necessity for additional randomised clinical trials in various groups of critically ill patients.

Keywords

• critical care
• diabetes mellitus
• hyperglycaemia
• insulin therapy