Even a modest degree of hyperglycemia was associated with a substantial increase in deaths in patients with a wide range of medical and surgical diagnoses, says James Krinsley, M.D., director of critical care at The Stamford Hospital in Stamford, Conn., and author of the study.
Hyperglycemia is common in critically ill adults. Standard clinical practice has been to tolerate a moderate degree of hyperglycemia in these patients. However, Dr. Krinsley says the findings from this study suggest a new approach to glucose management in the intensive care unit, and should prompt additional studies.
"Although hyperglycemia can be a marker of severity of illness, it may also worsen outcomes," Dr. Krinsley says. "We think that tight glucose control results in improved vascular function and lower risk of infection."
Dr. Krinsley, who is an associate clinical professor of medicine at the Columbia University College of Physicians and Surgeons, reviewed data for 1,826 patients whose glucose values were obtained during their intensive care unit stay at The Stamford Hospital between Oct. 1, 1999, and April 4, 2002. The lowest death rates occurred in patients whose average glucose levels were in the lower end of the normal range. Death rates increased as the average glucose levels increased. This association was noted among people with and without diabetes.
Based on these findings, a multidisciplinary team at The Stamford Hospital has developed a protocol for intensive monitoring and treatment of glucose levels of patients admitted to the critical care unit. The team is studying whe