Better intensive care blood sugar control lowers mortality rates

 

A study appearing in the August 2004 issue of Mayo Clinic Proceedings reported that strictly controlling blood glucose lowers mortality patients in intensive care units (ICUs).

James Krinsley, MD, who is the director of critical care at The Stamford Hospital in Stamford, Connecticut, compared 800 patients admitted to the hospital's intensive care unit prior to the initiation of a glucose management protocol to 800 patients admitted after the protocol was adopted. The glucose management protocol specifies intensive monitoring of blood glucose and treating elevations of greater than 140 milligrams per deciliter with insulin.

The protocol was based on the work of Greet van den Berge, MD, PhD, of the University of Leuven in Lueven, Belgium, who found decreased mortality and less organ dysfunction in surgical ICU patients requiring ventilation who received intensive glucose management.

Earlier work by Dr Krinsley, inspired by the work of Dr van den Berge and also published in Mayo Clinic Proceedings, revealed a positive relationship between glucose levels and mortality in critically ill individuals. In the current study, Dr Krinsley observed a reduction in deaths of 29.3 percent in patients treated with the protocol compared to those who were admitted before the protocol was initiated, representing 49 lives. In addition, new cases of kidney failure, the need for blood transfusions, and length of intensive care stay were reduced in the treated patients.

The study is the first to demonstrate that intensive management of blood glucose reduces mortality among a general population of critically ill patients similar to those found in most intensive care units. Dr Krinsley predicted, "This is a low-cost, effective intervention that can profoundly affect patients. Intensive glucose management will eventually become a standard of care in ICUs (intensive care units) worldwide."

-D Dye