Strict blood glucose control in sick children ‘no benefit’
Strict blood sugar control in critically ill children with diabetes being treated in intensive care provides no further benefit to their health, research has suggested.
In fact, the study was stopped early because the young participants in the control group were suffering from more infections and low glucose levels.
This trial found that using insulin to control blood sugar to within 4.4 to 6.1 mmol/L, rather than 8.3 to 10mmol/L, in critically ill children made no difference to the number of days they spent in the intensive care unit.
The researchers said the study findings indicate that “maintaining blood sugar control within tight boundaries in this group is of no benefit and may be harmful”.
The team have recommended targets for blood sugar levels for critically ill children should be reviewed.
The study was carried out because previous research looking into tight glycemic control have not been shown to improve outcomes in critically ill adults or children after cardiac surgery. The researchers say there was also a lack of evidence into critically ill children who have not undergone cardiac surgery.
During the 35-centre trial, 713 critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) were randomly assigned to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-target group) or 150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-target group).
Doctors were then guided by continuous glucose monitoring and explicit methods for insulin adjustment. The primary outcome was the number of intensive care unit (ICU)-free days to day 28.
There is sparse evidence for the optimum blood sugar range for critically ill children with hyperglycaemia. Intensive care paediatricians have varying opinions on the threshold for starting insulin management in critically ill children, and according to some sources few would be willing to target a blood glucose level of less than 6.1 mmol/L.
The researchers said this trial indicates targeting a normal blood sugar level in critically ill hyperglycaemic children is of “no benefit compared with a higher, more relaxed target, and may be harmful”. This fits with other recent evidence. Intensivists should consider a more permissive approach to blood sugar management in critically ill children.