Glycemic stability may be important key to recovery from critical illness

Widely varying blood glucose levels may pose as great a threat, or possibly a greater threat, to critically ill patients as high, but steady, glycemic levels, according to researchers in Saudi Arabia, who will present their findings at the American Thoracic Society's 2008 International Conference in Toronto on Tuesday, May 20.

"We found that patients with wide fluctuation were significantly more likely to die in the intensive care unit and the hospital than those who experience low glycemic variability," said Hasan M. Al-Dorzi, M.D., who led the research at King AdbulAziz Medical City, in Riyadh. "This finding may lead to further research that changes our focus from only treating high blood glucose to also minimizing changes in glycemic levels."

Other studies have shown that glycemic variability increases diabetic complications. This study is one of the first to evaluate glycemic variability and the outcomes of critically ill patients.

To conduct the study, the researchers evaluated a nested cohort of 523 patients who were prospectively randomized to either intensive or conventional insulin therapy. After evaluating the daily blood glucose range of all the patients and determining a median, the patients were divided into two groups: those with high variability of blood glucose levels and those with low variability.

Patients in the high variability group were 12 percent more likely to die. They were also more likely to develop a nosocomial infection while in the hospital.

The study identified three predictors of glycemic variability: age, previous diabetes history and whether the patient's diabetes was controlled with insulin.

Dr. Al-Dorzi suggested that future research could result in improved care for these patients by establishing a standard definition of high variability and developing ways for minimizing blood glucose changes. The latter, he explained, might require an "automated, continuous blood glucose measurement system with computerized insulin protocols."


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