دورية أكاديمية
The effect of a liberal approach to glucose control in critically ill patients with type 2 diabetes: a multicenter, parallel-group, open-label randomized clinical trial
| العنوان: | The effect of a liberal approach to glucose control in critically ill patients with type 2 diabetes: a multicenter, parallel-group, open-label randomized clinical trial |
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| المؤلفون: | Poole, A.P., Finnis, M.E., Anstey, J., Bellomo, R., Bihari, S., Biradar, V., Doherty, S., Eastwood, G., Finfer, S., French, C.J., Heller, S., Horowitz, M., Kar, P., Kruger, P.S., Maiden, M.J., Mårtensson, J., McArthur, C.J., McGuinness, S.P., Secombe, P.J., Tobin, A.E., Udy, A.A., Young, P.J., Deane, A.M., Schultz, R., Secombe, P., Butler, M., Cowdrey, K.-A., Gilder, E., McGuinness, S., O’Connor, K., Parke, R., Ryan, S., Woolett, M., Chen, Y., McArthur, C., McConnochie, R., Newby, L., Simmonds, C., Peck, L., Young, H., Comerford, S., Jin, X., Bates, S., French, C., Marshall, F., McEldrew, R., Morgan, R., Tippett, A., Towns, M., Morrison, L., Sutton, J., White, H., Soar, N., Harward, M., Kruger, P., Mackay, J., Meyer, J., Saylor, E., Wetzig, K., Brown, N., Finnis, M., Glasby, K., O’Connor, S., Poole, A., Rivett, J., Barge, D., Byrne, K., Clancy, A., Deane, A., Driscoll, A., Barbazza, L., Holmes, J., Smith, R., Tobin, A., Board, J., Martin, E., McCracken, P., Udy, A., Vallance, S., Young, M., Bone, A., Horton, M., Maiden, M., Salerno, T., Trickey, J., Latimer-Bell, C., Delaney, K., Hendry, D., Lawrence, C., Lesona, E., Milington, A., Navarra, L., Olatunji, S., Cruz, R.S., Young, C., Young, P. |
| بيانات النشر: | American Thoracic Society |
| سنة النشر: | 2022 |
| المجموعة: | White Rose Research Online (Universities of Leeds, Sheffield & York) |
| الوصف: | Rationale: Blood glucose concentrations affect outcomes in critically ill patients, but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objectives: To evaluate the effects of a “liberal” approach to targeted blood glucose range during ICU admission. Methods: This mutlicenter, parallel-group, open-label randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. In the intervention group intravenous insulin was commenced at a blood glucose >252 mg/dl and titrated to a target range of 180–252 mg/dl. In the comparator group insulin was commenced at a blood glucose >180 mg/dl and titrated to a target range of 108–180 mg/dl. The primary outcome was incident hypoglycemia (<72 mg/dl). Secondary outcomes included glucose metrics and clinical outcomes. Measurements and Main Results: By Day 28, at least one episode of hypoglycemia occurred in 10 of 210 (5%) patients assigned the intervention and 38 of 209 (18%) patients assigned the comparator (incident rate ratio, 0.21 [95% confidence interval (CI), 0.09 to 0.49]; P < 0.001). Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability, and less relative hypoglycemia (P < 0.001 for all comparisons). By Day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference, 4.6 percentage points [95% CI, −3.9% to 13.2%]; P = 0.29). Conclusions: A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN 12616001135404). |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | text |
| اللغة: | English |
| العلاقة: | https://eprints.whiterose.ac.uk/195517/3/LUCID%20Manuscript%20ATS%20v2%202022_04_27_PM.pdfTest; Poole, A.P., Finnis, M.E., Anstey, J. et al. (106 more authors) (2022) The effect of a liberal approach to glucose control in critically ill patients with type 2 diabetes: a multicenter, parallel-group, open-label randomized clinical trial. American Journal of Respiratory and Critical Care Medicine, 206 (7). pp. 874-882. ISSN 1073-449X |
| DOI: | 10.1164/rccm.202202-0329oc |
| الإتاحة: | https://doi.org/10.1164/rccm.202202-0329ocTest https://eprints.whiterose.ac.uk/195517Test/ https://eprints.whiterose.ac.uk/195517/3/LUCID%20Manuscript%20ATS%20v2%202022_04_27_PM.pdfTest |
| رقم الانضمام: | edsbas.9F1866A6 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1164/rccm.202202-0329oc |
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