Featured Research

from universities, journals, and other organizations

Intermediate glucose control may be better than tight glycemic control in neurocritical care patients

Date:
October 22, 2012
Source:
BioMed Central Limited
Summary:
A new study suggests that intensive glycemic control does not reduce mortality in neurocritical care patients and could, in fact, lead to more neurological damage. Complicating the picture, poor glucose control also leads to worse recovery and should be avoided. This study suggests that a strategy to maintain intermediate glucose levels would contribute to better outcomes in these patients.

A new study in BioMed Central's open access journal Critical Care suggests that intensive glycemic control does not reduce mortality in neurocritical care patients and could, in fact, lead to more neurological damage. Complicating the picture, poor glucose control also leads to worse recovery and should be avoided. This study suggests that a strategy to maintain intermediate glucose levels would contribute to better outcomes in these patients.

Related Articles


Hyperglycemia and hypoglycemia are common in critically ill patients and are strongly associated with worse outcomes. This is particularly important for neurologically ill patients, for whom poor glycemic control could contribute to secondary neurological damage. Hyperglycemia is known to be very harmful in such patients, potentially leading to further brain damage andincreased mortality.

On the other hand, hypoglycemia could cause neuroglycopenia -- a shortage of glucose in the brain -- which can lead to loss of consciousness, brain damage and, in some cases, even death. For these reasons, the same optimal glycemic targets for general critical care patients may not apply for neurologically injured patients.

Numerous randomized controlled trials (RCTs) have assessed the efficacy and safety of intensive insulin therapy and tight glycemic control regimens for critically ill patients, though these largely focus on mortality as the primary outcome, rather than functional recovery, which would be a more meaningful endpoint for neurological patients.

With the aim of determining better glycemic targets for neurologically injured patients, a research group from the Department of Critical Care Medicine at the University of Calgary, Canada, performed a systematic review and meta-analysis of RCTs comparing intensive insulin therapy to conventional glycemic control, among patients with neurological injuries, including traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infection or spinal cord injury.

Sixteen RCTs, a combined total of 1,248 neurocritical care patients, were included. In the trials, glycemic control targets with intensive insulin ranged from 70-140 mg/dl, while conventional protocols aimed to keep glucose levels below 144-300 mg/dl.

Consistent with the results of recent large multicenter RCTs in non-neurological patients, the authors found that intensive glucose control did not reduce mortality among their neurocritical care patients, but it did reduce the occurrence of poor neurological outcomes. However, intensive insulin therapy significantly increases the risk of hypoglycemia. A benefit was not observed when intensive treatment was compared with more intermediate glycemic targets of 110-180mg/dl.

According to lead author Andreas Kramer, "Tight glucose control doesn't appear to improve mortality in neurocritical care patients." He continued, "Very loose glucose control is associated with worse neurological recovery and should be avoided. Our results support targeting more intermediate glycemic goals."


Story Source:

The above story is based on materials provided by BioMed Central Limited. Note: Materials may be edited for content and length.


Journal Reference:

  1. Andreas H Kramer, Derek J Roberts, David A Zygun. Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis. Critical Care, 2012; 16 (5): R203 DOI: 10.1186/cc11812

Cite This Page:

BioMed Central Limited. "Intermediate glucose control may be better than tight glycemic control in neurocritical care patients." ScienceDaily. ScienceDaily, 22 October 2012. <www.sciencedaily.com/releases/2012/10/121022080609.htm>.
BioMed Central Limited. (2012, October 22). Intermediate glucose control may be better than tight glycemic control in neurocritical care patients. ScienceDaily. Retrieved April 25, 2015 from www.sciencedaily.com/releases/2012/10/121022080609.htm
BioMed Central Limited. "Intermediate glucose control may be better than tight glycemic control in neurocritical care patients." ScienceDaily. www.sciencedaily.com/releases/2012/10/121022080609.htm (accessed April 25, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Saturday, April 25, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

85 Killed in Niger by Meningitis Since Start of Year

85 Killed in Niger by Meningitis Since Start of Year

AFP (Apr. 24, 2015) A meningitis outbreak in Niger has killed 85 people since the start of the year prompting authorities to close schools in the capital Niamey until Monday. Video provided by AFP
Powered by NewsLook.com
C-Section Births a Trend in Brazil

C-Section Births a Trend in Brazil

AFP (Apr. 24, 2015) More than half of Brazil&apos;s babies are born via cesarean section, as mothers and doctors opt for a faster and less painful experience despite the health risks. Duration: 02:02 Video provided by AFP
Powered by NewsLook.com
Anti-Malaria Jab Hope

Anti-Malaria Jab Hope

Reuters - News Video Online (Apr. 24, 2015) The world&apos;s first anti-malaria vaccine could get the go-ahead for use in Africa from October if approved by international regulators. Paul Chapman reports. Video provided by Reuters
Powered by NewsLook.com
3D Food Printing: The Meal of the Future?

3D Food Printing: The Meal of the Future?

AP (Apr. 23, 2015) Developers of 3D food printing hope the culinary technology will revolutionize the way we cook and eat. (April 23) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins