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At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
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Critical Care
Published in: Critical Care 5/2014

Open Access 01-10-2014 | Research

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

Authors: Raphaël Cinotti, Carole Ichai, Jean-Christophe Orban, Pierre Kalfon, Fanny Feuillet, Antoine Roquilly, Bruno Riou, Yvonnick Blanloeil, Karim Asehnoune, Bertrand Rozec

Published in: Critical Care | Issue 5/2014

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Abstract

Introduction

Hyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery.

Methods

A sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. Patients with severe brain injury, with an expected ICU length of stay ≥48 hours were included. Patients were randomized between a conventional glucose management group (blood glucose target between 5.5 and 9 mmol.L−1) and an IIT group (blood glucose target between 4.4 and 6 mmol.L−1). The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale.

Results

A total of 188 patients were included in this analysis. In total 98 (52%) patients were randomized in the control group and 90 (48%) in the IIT group. The mean Glasgow coma score at baseline was 7 (±4). Patients in the IIT group received more insulin (130 (68 to 251) IU versus 74 (13 to 165) IU in the control group, P = 0.01), had a significantly lower morning blood glucose level (5.9 (5.1 to 6.7) mmol.L−1 versus 6.5 (5.6 to 7.2) mmol.L−1, P <0.001) in the first 5 days after ICU admission. The IIT group experienced more episodes of hypoglycemia (P <0.0001). In the IIT group 24 (26.6%) patients had a favorable neurological outcome (good recovery or moderate disability) compared to 31 (31.6%) in the control group (P = 0.4). There were no differences in day-28 mortality. The occurrence of hypoglycemia did not influence the outcome.

Conclusions

In this sub-group analysis of a large multicenter randomized trial, IIT did not appear to alter the day-90 neurological outcome or ICU morbidity in severe brain injured patients or ICU morbidity.
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Metadata
Title
Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study
Authors
Raphaël Cinotti
Carole Ichai
Jean-Christophe Orban
Pierre Kalfon
Fanny Feuillet
Antoine Roquilly
Bruno Riou
Yvonnick Blanloeil
Karim Asehnoune
Bertrand Rozec
Publication date
01-10-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-014-0498-9

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