Journal of Clinical and Diagnostic Research. 2019 Sep, Vol-13(9): BC01-BC03 1 1 DOI: 10.7860/JCDR/2019/42058.13133 Original Article Intensive care Section Glycaemic Control and Mortality Outcomes in Intensive Care Unit INTRODUCTION Hyperglycaemia is associated with poor outcomes and increased mortality in critically ill patients [1]. Hyperglycaemia influence the patients’ outcomes due to its suppressive effects on immune function, that increases the risk of infection, endothelial damage, mitochondrial damage in hepatocytes and tissue ischemia due to acidosis and inflammation [2]. Despite decades of research, the effect of IIT on ICU mortality rates and hypoglycaemia remains debatable [3]. Clinical trials on use of IIT have reported improved glycaemic control, and decreased mortality, organ dysfunction, and length of stay in the ICU in medical and surgical critically ill patients. On the contrary, some published data suggest that IIT neither benefits nor harms patients during cardiac surgical procedures or those recovering from cardiac arrest [4]. While intervention trials report improvement in patient’s outcomes, other studies reports that IIT is associated with increased risk of hypoglycaemia [5,6]. Regardless of the conflicting conclusions, American Diabetes Association (ADA) recommends intensive insulin therapy as the standard of care for critically ill patients [7]. Owing to the inconsistent results, the present study was designed to determine the effect of tight blood glucose via CIT and IIT on mortality rates in critically ill ICU patients. MATERIALS AND METHODS The prospective observational study was conducted at Yenepoya Medical College and Hospital, Karnataka, India. The study was approved by the Institutional Ethical Committee (YEC-1/080). After obtaining informed written consent, 325 clinically diagnosed diabetic patients admitted in ICU from January 2018 to December 2018 were enrolled for the study. Sample size was calculated using G-power software with a level of significance, α=5%, and power of study, 1-β=80%. Random Blood Sugar (RBS) and HbA1c levels during admission in ICU were measured. Age, gender, duration of DM, co-morbidities, SOFA score, APACHE II score, hypoglycaemia status, drug history, Acute Kidney Injury (AKI) and mortality were recorded for all study participants [8,9]. Capillary blood sugar was measured after every one hour using glucometer (Glucocard-Arkray Healthcare Pvt. Ltd., GT-1070). On ICU admission, patients were randomly assigned to Intensive Insulin Therapy or the Conventional approach by blinded envelopes. In the conventional group, continuous insulin infusion with 50 IU Actrapid HM (Novo Nordisk from Denmark) in 50 mL of 0.9% Sodium chloride (Perfusor-FM pump) was started when blood glucose levels rose above 215 mg/dL and was adjusted to maintain blood glucose levels between 180-200 mg/dL. For IIT, insulin dose was adjusted according to whole blood glucose levels, measured at 1- to 4-h intervals using glucometers. If the patient was hypoglycaemic, insulin administration was halted and DW 50% in the volume of (100-BS) × 0.4 mL was infused to the patient and sampling was performed every 30 min until he/she was euglycaemic. When patients were haemodynamically stable, feeding was started. Parenteral supplements were given to meet estimated caloric needs, when sufficient amount of calories could not be given enterally. STATISTICAL ANALYSIS Data obtained were presented as mean±standard deviation and percentage, and analysed using Statistical Package for the Social Sciences (SPSS) version 16. The primary study outcome was mortality. Independent student t-test was used for comparing mean changes between two parameters and ANOVA for comparison of changes between the groups in quantitative variables. Chi-square test was used for analysing qualitative variables between groups. A two-sided p-value <0.05 was considered as statistically significant. HAJI MOHAMMED ISMAIL 1 , CS NAGALAKSHMI 2 , SHAHEEN BANU SHAIKH 3 , L NIVEDITA 4 Keywords: Critical care, Diabetes mellitus, Hyperglycaemia, Insulin therapy ABSTRACT Introduction: Hyperglycaemia is associated with adverse physiological outcome and high mortality rates in critically ill patients. Intensive Insulin Therapy (IIT) for glycaemic control often leads to hypoglycaemia and increases risk of death, therefore targeted glycaemic management in Intensive Care Unit (ICU) are need of the hour. Aim: To study whether achieving glycaemic control during stay in ICU can affect mortality rate in critically ill patients. Materials and Methods: The prospective observational study was conducted on 325 diabetic patients admitted in ICU at Yenepoya Medical College and Hospital, Karnataka. Upon admission to ICU, blood sugar and Glycated haemoglobin (HbA1c) levels were measured. Age, sex, duration of Diabetes Mellitus (DM), co-morbidities, Sequential organ failure assessment (SOFA) score, Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, hypoglycaemic episodes, and drug history were recorded. Following Conventional Insulin Therapy (CIT) and Intensive Insulin Therapy treatment, the mortality outcomes were documented. Independent student t-test was used to compare mean changes between two parameters and ANOVA was used for comparison of changes between the groups in quantitative variables. Chi-square test was used for analysing qualitative variables between groups. A two- sided p<0.05 was considered as statistically significant value. Results: The patient’s population was predominantly men 210 (64.6%), 190 (57%) were older than 60 years. ICU mortality was 110 (33.8%). 56.1% of patients received IIT and 43.1% of patients received CIT. Mortality in IIT was 75 (22.8%) and mortality in CIT was 250 (77.2%). Mortality was significantly lower (p<0.05) in the IIT group than in the CIT group. Conclusion: The results of the present research supports implementation of IIT in intensively ill patients of ICU. IIT in critically ill patients was associated with an overall reduction in morbidity and mortality. The present study’s results together with data from latest studies, suggest a need for the broad implementation of IIT and a rising necessity for additional randomised clinical trials in various groups of critically ill patients.