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Intensive Versus Intermediate Glucose Control in Surgical Intensive Care Unit Patients
Featured Article:
Takehiro Okabayashi, Yasuo Shima,Tatsuaki Sumiyoshi, Akihito Kozuki, Teppei Tokumaru, Tasuo Iiyama, Takeki Sugimoto, Michiya Kobayashi,
Masataka Yokoyama, and Kazuhiro Hanazaki
Diabetes Care Volume 37: 1516-1524
June, 2014
STUDY OBJECTIVE
• To determine whether surgical site infection (SSI) is reduced by perioperative intensive insulin therapy (IT)
Okabayashi T. et al. Diabetes Care 2014;1516-1524
STUDY DESIGN AND METHODS
• Patients were randomly assigned to perioperative intensive IT (target blood glucose of 4.4–6.1 mmol/L) or intermediate IT (target blood glucose 7.7–10.0 mmol/L) in the surgical intensive care unit (ICU)
• Primary end point defined as the incidence of SSI
Okabayashi T. et al. Diabetes Care 2014;1516-1524
RESULTS
• Participants were assigned to glucose control with one of two target ranges:
• 225 patients in the intermediate IT group or• 222 patients in the intensive IT group
• No patients in either group became hypoglycemic
• Rate of SSI after hepato-biliary-pancreatic surgery was 6.7%
Okabayashi T. et al. Diabetes Care 2014;1516-1524
RESULTS
• Patients in the intensive IT group had fewer postoperative SSIs and a lower incidence of postoperative pancreatic fistula after pancreatic resection
• Length of hospitalization in the intensive IT group was significantly shorter than in the intermediate IT group
Okabayashi T. et al. Diabetes Care 2014;1516-1524
CONCLUSIONS
• Intensive IT decreased the incidence of SSI among patients who underwent hepato-biliary-pancreatic surgery
• Blood glucose target of 4.4–6.1 mmol/L resulted in a lower rate of SSI than a target of 7.7–10.0 mmol/L
Okabayashi T. et al. Diabetes Care 2014;1516-1524