Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials

• Published in: Journal of intensive care medicine 2024-12, Vol.39 (12), p.1250-1255
• Main Authors: Defante, Maria L. R., Mendes, Beatriz Ximenes, de Souza, Mariana de Moura, De Hollanda Morais, Beatriz Austregésilo de Athayde, Martins, Otávio Cosendey, Prizão, Vitória Martins, Parolin, Salma Ali El Chab
• Format: Article
• Language: English
• Subjects: Blood Glucose - analysis; Critical Care - methods; Critical Illness - mortality; Critical Illness - therapy; Diabetes Mellitus - blood; Female; Glycemic Control; Humans; Hypoglycemic Agents - therapeutic use; Intensive Care Units; Male; Middle Aged; Randomized Controlled Trials as Topic
• ISSN: 0885-0666; 1525-1489; 1525-1489
• DOI: 10.1177/08850666241255671

Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.