ANZICS CTG Endorsed Study
Liberal glucose control in critically ill patients with pre-existing Type 2 Diabetes
Type 2 diabetes mellitus (T2DM) is a frequent pre-existing medical condition in critically ill patients. During critical illness patients with T2DM are often hyperglycaemic, which is treated with insulin infusions. Currently patients with T2DM are treated exactly like patients with previously ‘normal’ glucose tolerance, i.e. insulin is administered when blood glucose is ≥ 10 mmol/L and titrated to target < 10 mmol/L, regardless of T2DM.
Observational data consistently show that increases in blood glucose concentrations that are associated with harm in patients with pre-existing ‘normal’ glucose tolerance have no impact on mortality or morbidity in patients with T2DM. However, both hypoglycaemia (both absolute and relative) and glycaemic variability, which are inevitable outcomes from the administration of insulin, occur frequently and are strongly associated with adverse outcomes: specifically, there are strong associations between all of these glycaemic metrics and increased mortality. We have conducted two preliminary studies that show non-significant trends to reduce incident hypoglycaemia and attenuate glycaemic variability with a more liberal approach. Accordingly, we believe that patients with T2DM have the potential to benefit from a more liberal approach to blood glucose control when compared to current standard care.
James Anstey, Rinaldo Bellomo, Vishwanath Biradar, Adam Deane, Glenn Eastwood, Simon Finfer, Mark Finnis, Craig French, Simon Heller, Michael Horowitz, Palash Kar, Peter Kruger, Colin McArthur, Shay McGuinness, Johan Martensson, Matthew Maiden, Alexis Poole, Paul Secombe, Antony Tobin, Andrew Udy and Sophia Zoungas
Royal Adelaide Hospital
Intensive Care Foundation – Project Grant -$25,000
Diabetes Australia – Project Grant – $60,000
Project Status as of June 2018
Currently recruiting. Thirty percent of the proposed cohort have been enrolled with a likely final recruitment date of 31 Dec 2019.
CTG ID No 1617-004
Provisional ANCTR 12616001135404p