Effect of Glycemic Control on Intensive Care Mortality

Aim: Hyperglycemia is known to be closely associated with increased mortality and morbidity rates in intensive care unit (ICU) patients. However, studies aiming to determine glycemic control objectives in ICUs reveal contradictory results. In this study, we aimed to determine the glycemic control level in our ICU and its effects on ICU mortality. Material and Methods: This study was conducted in the 9-bed medical ICU and designed to include inpatients of this unit during a six-month period (November 2008-April 2009). General characteristics of the inpatients, together with the data related to glycemic control, were gathered and the data from surviving and non-surviving patients were compared. Blood sugar levels of patients were maintained between 110-150 mg/dL and hypoglycemia was considered when this was ≤50 mg/dL.Results: A total of 129 patients were included in the study. Mean age of the patients was 67 years and 55% of the patients were male. Average blood sugar of the patients was 138 mg/dL; average insulin dose applied was 20 unit/day and hypoglycemia frequency was 38%. The most significant difference between the surviving and non-surviving patients in the ICU in terms of glycemic control was the frequency of hypoglycemia in the non-surviving patients (49% vs 27%, p=0.012). When the curves for the surviving patients were compared, it was observed that the patients who had the highest surviving rates were those whose blood sugar was between 110 mg/dL and 150 mg/dL (18 days vs 8 days, p=0.005). In patients with severe hypoglycemia, not only were the lengths of stay in the intensive care unit extended, but also mortality rates increased (9 days vs 20 days; p=0.001).Conclusion: No studies have yet been able to reveal a precise target value for blood sugar in order to reduce mortality and morbidity in ICUs. In this study, it was found that a blood sugar value between 110 mg/dL and 150 mg/dL increased survival rates. Every ICU should determine a target blood sugar level that complies with its own conditions and implement appropriate protocols to achieve this goal long before severe hypoglycemia develops.