Critically ill children do not benefit clinically from tight glycaemic control
Critically ill children admitted to paediatric intensive care units do not benefit clinically from tight control of hyperglycaemia, using insulin infusion. However, tight control does have economic advantages for certain subgroups, a UK multicentre trial has found (New England Journal of Medicine 2014;370:107).
Severely ill patients in ICU often have stress hyperglycaemia. The trial compared the effects of allowing this natural rise in blood glucose to occur (conventional therapy, with target blood glucose below 12mmol/L) with controlling the rise using tight glycaemic control (target 4 to 7mmol/L). The trial involved 1,369 children in 13 paediatric ICUs; 60 per cent of the children were in the ICU after cardiac surgery.
Tight glycaemic control did not have a significant effect on major clinical outcomes. There was however significantly increased incidence of severe hypoglycaemia in the tight control group (7.3 per cent vs 1.5 per cent); in the cardiac surgery subgroup, hypoglycaemia was associated with increased mortality.
In children who had had cardiac surgery, the costs were similar with conventional and tight glycaemic control, but in those admitted to ICU for other reasons tight control was associated with a shorter hospital stay (average 13.5 days shorter) and healthcare costs at 12 months were around £10,000 per child lower than with conventional treatment.
Lead researcher Duncan Macrae, from the Royal Brompton Hospital, London, commented that the increased mortality associated with hypoglycaemia in the cardiac surgery subgroup supports conventional management of blood sugar levels in these patients. But for other patients, the economic analysis is more relevant, Dr Macrae argued. “Although we do not fully understand why controlling blood glucose levels during a child’s most critical days leads to a quicker recovery, evidence from this study suggests that doctors caring for very sick children who have not undergone heart surgery should consider controlling blood glucose levels more closely during intensive care,” he said.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11132977
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