Hypoglycemia and outcome in critically ill patients
Open accessAbstract
Objective To determine whether mild or moderate hypoglycemia that occurs in critically ill patients is independently associated with an increased risk of death.Patients and methods Of patients admitted to 2 hospital intensive care units (ICUs) in Melbourne and Sydney, Australia, from January 1, 2000, to October 14, 2004, we analyzed all those who had at least 1 episode of hypoglycemia (glucose concentration, <81 mg/dL). The independent association between hypoglycemia and outcome was statistically assessed.Results Of 4946 patients admitted to the ICUs, a cohort of 1109 had at least 1 episode of hypoglycemia (blood glucose level, <81 mg/dL). Of these 1109 patients (22.4% of all admissions to the intensive care unit), hospital mortality was 36.6% compared with 19.7% in the 3837 nonhypoglycemic control patients (P<.001). Even patients with a minimum blood glucose concentration between 72 and 81 mg/dL had a greater unadjusted mortality rate than did control patients (25.9% vs 19.7%; unadjusted odds ratio, 1.42; 95% confidence interval, 1.12-1.80; P=.004.) Mortality increased significantly with increasing severity of hypoglycemia (P<.001). After adjustment for insulin therapy, hypoglycemia was independently associated with increased risk of death, cardiovascular death, and death due to infectious disease.Conclusion In critically ill patients, an association exists between even mild or moderate hypoglycemia and mortality. Even after adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death.
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DPP-4 inhibitors plus low-dose basal insulin were as effective as basal-bolus insulin and were linked to less hypoglycemia and less treatment burden.
“DPP-4 inhibitors combined with low-dose basal insulin have been similarly effective to basal-bolus insulin and associated with less hypoglycemia and less treatment burden.1351,1354–1357,1359”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1354]
The Results and Clinical Implications passages discuss hypoglycemia and mortality in critically ill patients, not a comparison of DPP-4 inhibitors plus basal insulin with basal-bolus insulin. Searches for DPP-4 inhibitors, basal-bolus insulin, and treatment burden found no passage addressing the claimed effectiveness or advantages; page numbers were unavailable in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredOral DPP-4 inhibitors have been tested in RCTs in medical and surgical noncritically ill patients with mild hyperglycemia (admission glucose <180 mg/dL).
“Oral DPP-4 inhibitors have been tested in RCTs in medical and surgical noncritically ill persons with mild hyperglycemia (admission glucose <180 mg/dL).1351,1354–1357”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1354]
The Patients and Methods section describes patients in two intensive care units, not noncritically ill patients in trials of oral DPP-4 inhibitors. A search for DPP-4 inhibitors, sitagliptin, and the claimed admission-glucose threshold found no passage in our copy addressing those trials. The paper's 108–180 mg/dL figure is a glucose target, not an admission criterion. (LLM, conf=0.78)
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- Authors
- Egi, M., Bellomo, R., Stachowski, E., French, C. J., Hart, G. K., Taori, G., Hegarty, C., & Bailey, M.
- Affiliations
- Okayama University Hospital (JP)
- Monash University (AU)
- Westmead Hospital (AU)
- Western Hospital (AU)
- Austin Hospital (AU)
- Corresponding author
- Bellomo, Rinaldo
- Venue
- Mayo Clinic Proceedings
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 85
- Issue
- 3
- Pages
- 217-224
- ISSN
- 0025-6196 (ISSN-L)
- PMC
- PMC2843109
- OpenAlex
- W1999231148
- Cited by
- 432
- References
- 45
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 14 · 2023: 14 · 2022: 15 · 2021: 33 · 2020: 20 · 2019: 27 · 2018: 30 · 2017: 21 · 2016: 31 · 2015: 36 · 2014: 30 · 2013: 25 · 2012: 48
- FWCI
- 31.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Mayo Clinic Proceedings (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- hypoglycemia, critically ill patients, intensive care unit, mortality, insulin therapy, cardiovascular mortality, infectious disease mortality, blood glucose
- MeSH terms
- Blood Glucose, Cause of Death, Female, Follow-Up Studies, Humans, Hypoglycemia, Intensive Care Units, Male, Middle Aged, Morbidity, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Victoria, Survival Rate, Critical Illness, Hospital Mortality
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