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Tight Blood Sugar Control May Raise Risks in the ICU
Date:3/24/2009

d AACE have also convened a special inpatient task force to examine the issue.

"Complete recommendations from the panel will be published in Endocrine Practice and Diabetes Care later in the spring," according to the ADA/AACE statement. "Until more information is available, it seems reasonable for clinicians to treat critical care patients with the less intensive -- yet good -- glucose control strategies used in the conventional arm [of the study]."

Inzucchi also said that the best approach may be a more moderated control.

"Get the sugars down, but keeping them in the slightly elevated range, is probably not a bad thing, at least during the short course of most hospitalizations," he said. "Medicine is always changing as new evidence emerges. We need to incorporate new findings into our practice patterns."

And in similar research, a team led by Dr. Donald Griesdale of the University of British Columbia, Vancouver, examined data from 26 studies, including Finfer's.

Slated for publication in the April 14 issue of the Canadian Medical Association Journal, Griesdale's study found that insulin therapy designed to lower blood sugar in ICUs caused a six-fold increase in dangerously low blood sugar levels among patients.

"We suggest that policy-makers reconsider recommendations promoting the use of intensive insulin therapy in all critically ill patients," the authors wrote. However, because the study involved data from a spectrum of populations and illness severity, the team said that they "cannot exclude the possibility that some patients may benefit from intensive insulin therapy and be at less risk of hypoglycemic events."

More information

The Patient Education Institute has more on hypoglycemia.



SOURCES: Simon Finfer, F.R
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