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

• DOI: 10.1164/rccm.202202-0329oc
• Publication Date: 2022-05-24T14:49:03Z
• Authors: Alexis P. Poole; Mark E. Finnis; James Anstey; Rinaldo Bellomo; Shailesh Bihari; Vishwanath Biradar; Sarah Doherty; Glenn Eastwood; Simon Finfer; Craig J. French; Simon Heller; Michael Horowitz; Palash Kar; Peter S. Kruger; Matthew J. Maiden; Johan Mårtensson; Colin J. McArthur; Shay P. McGuinness; Paul J. Secombe; Antony E. Tobin; Andrew A. Udy; Paul J. Young; Adam M. Deane; Rebecca Schultz; Paul Secombe; Magdalena Butler; Keri-Anne Cowdrey; Eileen Gilder; Shay McGuinness; Karina O’Connor; Rachael Parke; Samantha Ryan; Melissa Woolett; Yan Chen; Colin McArthur; Rachael McConnochie; Lynette Newby; Catherine Simmonds; Rinaldo Bellomo; Glenn Eastwood; Leah Peck; Helen Young; Shailesh Bihari; Sharon Comerford; Xia Jin; Samantha Bates; Craig French; Fiona Marshall; Rebecca McEldrew; Rebecca Morgan; Anna Tippett; Miriam Towns; Lynette Morrison; Joanne Sutton; Hayden White; Vishwanath Biradar; Natalie Soar; Meg Harward; Peter Kruger; Josephine Mackay; Jason Meyer; Emma Saylor; Krista Wetzig; Nerissa Brown; Mark Finnis; Kathleen Glasby; Stephanie O’Connor; Alex Poole; Justine Rivett; James Anstey; Deborah Barge; Kathleen Byrne; Annabelle Clancy; Adam Deane; Alana Driscoll; Leanne Barbazza; Jennifer Holmes; Roger Smith; Anthony Tobin; Samantha Bates; Craig French; Fiona Marshall; Rebecca McEldrew; Rebecca Morgan; Anna Tippett; Miriam Towns; Jasmin Board; Emma Martin; Phoebe McCracken; Andrew Udy; Shirley Vallance; Meredith Young; Allison Bone; Michelle Horton; Matthew Maiden; Tania Salerno; Jemma Trickey; Charlie Latimer-Bell; Kirsha Delaney; Deborah Hendry; Cassie Lawrence; Eden Lesona; Alexandra Milington; Leanlove Navarra; Shaanti Olatunji; Raulle Sol Cruz; Rose Sol Cruz; Chelsea Young; Paul Young
• Keywords: Adult; Blood Glucose; diabetes; Critical Illness; Australia; 610; Hypoglycemia; 03 medical and health sciences; hypoglycemia; 0302 clinical medicine; Diabetes Mellitus, Type 2; Diabetes Mellitus; blood glucose; critical illness; Humans; Hypoglycemic Agents; Insulin; Type 2; LUCID Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG); intensive care

Rationale: Blood glucose concentrations affect outcomes in critically ill patients, but the optimal target blood range those with type 2 diabetes is unknown. Objectives: To evaluate effects of a "liberal" approach to targeted during ICU admission. Methods: This mutlicenter, parallel-group, open-label randomized clinical trial included 419 adult patients expected be on at least three consecutive days. In intervention group intravenous insulin was commenced >252 mg/dl and titrated 180-252 mg/dl. comparator >180 108-180 The primary outcome incident hypoglycemia (<72 mg/dl). Secondary metrics outcomes. Measurements Main Results: By Day 28, one episode occurred 10 210 (5%) assigned 38 209 (18%) (incident rate ratio, 0.21 [95% confidence interval (CI), 0.09 0.49]; P < 0.001). Those had greater (daily mean, minimum, maximum), less variability, relative (P 0.001 for all comparisons). 90, 62 (29.5%) 52 (24.9%) died (absolute difference, 4.6 percentage points CI, -3.9% 13.2%]; = 0.29). Conclusions: A liberal targets reduced did not improve patient-centered Clinical registered Australian New Zealand Trials Registry (ACTRN 12616001135404).