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Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study

INTRODUCTION: There is no information on the uptake of Intensive Insulin Therapy (IIT) before the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial in Australia and New Zealand (ANZ) and on the bi-national response to the trial, yet such d...

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Autores principales: Kaukonen, Kirsi-Maija, Bailey, Michael, Pilcher, David, Orford, Neil, Finfer, Simon, Bellomo, Rinaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056083/
https://www.ncbi.nlm.nih.gov/pubmed/24088368
http://dx.doi.org/10.1186/cc13030
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author Kaukonen, Kirsi-Maija
Bailey, Michael
Pilcher, David
Orford, Neil
Finfer, Simon
Bellomo, Rinaldo
author_facet Kaukonen, Kirsi-Maija
Bailey, Michael
Pilcher, David
Orford, Neil
Finfer, Simon
Bellomo, Rinaldo
author_sort Kaukonen, Kirsi-Maija
collection PubMed
description INTRODUCTION: There is no information on the uptake of Intensive Insulin Therapy (IIT) before the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial in Australia and New Zealand (ANZ) and on the bi-national response to the trial, yet such data would provide important information on the evolution of ANZ practice in this field. We aimed to study ANZ glycaemic control before and after the publication of the results of the NICE-SUGAR trial. METHODS: We analysed glucose control in critically ill patients across Australia and New Zealand during a two-year period before and after the publication of the NICE-SUGAR study. We used the mean first day glucose (Glu(1)) (a validated surrogate of ICU glucose control) to define practice. The implementation of an IIT protocol was presumed if the median of Glu(1) measurements was <6.44 mmol/L for a given ICU. Hypoglycaemia was categorised as severe (glucose ≤2.2 mmol/L) or moderate (glucose ≤3.9 mmol/L). RESULTS: We studied 49 ICUs and 176,505 patients. No ICU practiced IIT before or after NICE-SUGAR. Overall, Glu(1) increased from 7.96 (2.95) mmol/L to 8.03 (2.92) mmol/L (P <0.0001) after NICE-SUGAR. Similar increases were noted in all patient subgroups studied (surgical, medical, insulin dependent diabetes mellitus, ICU stay >48/<48 hours). The rate of severe and moderate hypoglycaemia before and after NICE-SUGAR study were 0.59% vs. 0.55% (P =0.33) and 6.62% vs. 5.68% (P <0.0001), respectively. Both crude and adjusted mortalities declined over the study period. CONCLUSIONS: IIT had not been adopted in ANZ before the NICE-SUGAR study and glycaemic control corresponded to that delivered in the control arm of NICE-SUGAR trial. There were only minor changes in practice after the trial toward looser glycaemic control. The rate of moderate hypoglycaemia and mortality decreased along with such changes.
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spelling pubmed-40560832014-06-14 Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study Kaukonen, Kirsi-Maija Bailey, Michael Pilcher, David Orford, Neil Finfer, Simon Bellomo, Rinaldo Crit Care Research INTRODUCTION: There is no information on the uptake of Intensive Insulin Therapy (IIT) before the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial in Australia and New Zealand (ANZ) and on the bi-national response to the trial, yet such data would provide important information on the evolution of ANZ practice in this field. We aimed to study ANZ glycaemic control before and after the publication of the results of the NICE-SUGAR trial. METHODS: We analysed glucose control in critically ill patients across Australia and New Zealand during a two-year period before and after the publication of the NICE-SUGAR study. We used the mean first day glucose (Glu(1)) (a validated surrogate of ICU glucose control) to define practice. The implementation of an IIT protocol was presumed if the median of Glu(1) measurements was <6.44 mmol/L for a given ICU. Hypoglycaemia was categorised as severe (glucose ≤2.2 mmol/L) or moderate (glucose ≤3.9 mmol/L). RESULTS: We studied 49 ICUs and 176,505 patients. No ICU practiced IIT before or after NICE-SUGAR. Overall, Glu(1) increased from 7.96 (2.95) mmol/L to 8.03 (2.92) mmol/L (P <0.0001) after NICE-SUGAR. Similar increases were noted in all patient subgroups studied (surgical, medical, insulin dependent diabetes mellitus, ICU stay >48/<48 hours). The rate of severe and moderate hypoglycaemia before and after NICE-SUGAR study were 0.59% vs. 0.55% (P =0.33) and 6.62% vs. 5.68% (P <0.0001), respectively. Both crude and adjusted mortalities declined over the study period. CONCLUSIONS: IIT had not been adopted in ANZ before the NICE-SUGAR study and glycaemic control corresponded to that delivered in the control arm of NICE-SUGAR trial. There were only minor changes in practice after the trial toward looser glycaemic control. The rate of moderate hypoglycaemia and mortality decreased along with such changes. BioMed Central 2013 2013-10-02 /pmc/articles/PMC4056083/ /pubmed/24088368 http://dx.doi.org/10.1186/cc13030 Text en Copyright © 2013 Kaukonen et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Kaukonen, Kirsi-Maija
Bailey, Michael
Pilcher, David
Orford, Neil
Finfer, Simon
Bellomo, Rinaldo
Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title_full Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title_fullStr Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title_full_unstemmed Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title_short Glycaemic control in Australia and New Zealand before and after the NICE-SUGAR trial: a translational study
title_sort glycaemic control in australia and new zealand before and after the nice-sugar trial: a translational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056083/
https://www.ncbi.nlm.nih.gov/pubmed/24088368
http://dx.doi.org/10.1186/cc13030
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