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Intensive Care Medicine

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01-01-2017 | Systematic Review

The optimal target for acute glycemic control in critically ill patients: a network meta-analysis

Authors: Tomoaki Yatabe, Shigeaki Inoue, Masahiko Sakaguchi, Moritoki Egi

Published in: Intensive Care Medicine | Issue 1/2017

Abstract

Purpose

The optimal target blood glucose concentration for acute glycemic control remains unclear because few studies have directly compared 144–180 with 110–144 or >180 mg/dL. Accordingly, we performed a network meta-analysis to compare four different target blood glucose levels (<110, 110–144, 144–180, and >180 mg/dL) in terms of the benefit and risk of insulin therapy.

Methods

We included all of the studies from three systematic reviews and searched the PubMed and Cochrane databases for other studies investigating glucose targets among critically ill patients. The primary outcome was hospital mortality, and the secondary outcomes were sepsis or bloodstream infection and the risk of hypoglycemia. Network meta-analysis to identify an optimal target glucose concentration.

Results

The network meta-analysis included 18,098 patients from 35 studies. There were no significant differences in the risk of mortality and infection among the four blood glucose ranges overall or in subgroup analysis. Conversely, target concentrations of <110 and 110–144 mg/dL were associated with a four to ninefold increase in the risk of hypoglycemia compared with 144–180 and >180 mg/dL. However, there were no significant differences between the target concentrations of 144–180 and >180 mg/dL.

Conclusions

This network meta-analysis found no significant difference in the risk of mortality and infection among four target blood glucose ranges in critically ill patients, but indicated that target blood glucose levels of <110 and 110–144 mg/dL were associated with a higher risk of hypoglycemia than target levels of 144–180 and >180 mg/dL. Further studies are required to refute or confirm our findings.

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Title: The optimal target for acute glycemic control in critically ill patients: a network meta-analysis
Authors: Tomoaki Yatabe
Shigeaki Inoue
Masahiko Sakaguchi
Moritoki Egi
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 1/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4558-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The optimal target for acute glycemic control in critically ill patients: a network meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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