Post-ICU glucose management may improve outcomes in critical patients
Monitoring and maintaining glucose levels of critically ill patients after admission from ICU through general care and discharge from the hospital may have positive impact on outcomes, according to findings published in the July 7, 2017 issue of the journal Mayo Clinic Proceedings.
"Our research suggests that the glucose blood level of critical patients transferred back to general care matters – specifically control of dysglycemia (hyper, hypo and glucose variability) – which were all independently associated with mortality in patients without diabetes," said James Krinsley, MD, Director of Critical Care at Stamford Hospital and Clinical Professor of Medicine, Columbia University College of Physicians. "The data also suggests that patients should have blood glucose targets based on their personal characteristics rather than a 'one-size-fits-all' approach as current guidelines state."
The article, "Glucose control, diabetes status and mortality in critically ill patients: the continuum from ICU admission to hospital discharge," supports the importance of glucose control throughout the entire period of care for critically ill patients – and suggest that the current blood glucose target range may not be appropriate for patients without diabetes.
In collaboration with Stanley Nasraway, MD, Director, Surgical Intensive Care Unit and Professor, Tufts University School of Medicine in Boston, Dr. Krinsley conducted a retrospective investigation of the relationship between mean blood glucose, hypoglycemia, high glucose variability, diabetes and mortality among nearly 6,400 ICU patients with five or more blood glucose tests and nearly 4,500 ICU survivors admitted at two academic medical centers between July 2010 and December 2014.
"Our investigation, in combination with other recent literature, suggests that for people without diabetes, a target glucose level of 80-14 mg/dL is strongly associated with best prospects for survival," added Dr. Krinsley. "We believe this study is the first to report on the association of glucose control with mortality in a cohort of critically ill patients spanning the entire continuum of hospitalization."
The data suggests that broader glucose control protocols, from admission to the ICU through discharge, may result in greater survivability for the critical-care patient. For patients without diabetes, it appears a blood glucose range of 80-140 mg/dL as a mean glucose level, is strongly associated with survival, both in the ICU and on the general floor. However, there was no clear relationship between blood glucose level and mortality for patients with diabetes in the ICU or the floor. The next step would be to institute randomized controlled trials to see if protocols for glucose control instituted in general care floors lead to better outcomes.
The other collaborators, respectively, were Paula Maurer, RN, BSN, Healthcare Decisions Network; Sharon Holewinski, RN, Critical Care, Tufts Medical Center; Roy Hayes, Department of Systems & Information Engineering, University of Virginia; Douglas McComsey, Medical Decisions Network; and Guillermo Umpierrez, MD, Professor of Medicine, Division of Endocrinology and Metabolism at Emory University School of Medicine. The article can be found on the Mayo Clinic Proceedings website, here: http://www.mayoclinicproceedings.org/article/S0025-6196(17)30320-8/fulltext.
About Stamford Health
Stamford Health is a not-for-profit healthcare system in lower Fairfield County. The system provides inpatient, outpatient and ambulatory services through Stamford Hospital, a 305-bed acute care tertiary hospital; Stamford Health Medical Group, a partnership of primary and specialty care physicians; Stamford Hospital Foundation; and a diverse and growing number of retail and ambulatory locations across the region. Stamford Health is affiliated with the NewYork-Presbyterian Healthcare System and is a major teaching affiliate of the Columbia University College of Physicians and Surgeons. HSS Orthopedics at Stamford Health is a collaboration with Hospital for Special Surgery to provide access to advanced orthopedic care. Stamford Health's Carl and Dorothy Bennett Cancer Center is a member of the Dana-Farber/Brigham and Women's Cancer Care Collaborative. Stamford Hospital received Magnet® Designation for nursing excellence in 2016, and the Planetree Distinction Award for Leadership and Innovation in Patient-Centered Care in 2014. For more information, visit StamfordHealth.org.