Fascinant quand même de nombre d'études qui se publient sur L'ABSENCE de gains dans divers contextes d'un contrôle serré de la glycémie! Alain
_____ From: [email protected] [mailto:[email protected]] On Behalf Of Équipe éditoriale de amc.ca Sent: 25 mars 2009 04:00 To: [email protected] Subject: InfoPOEM: Intensive glucose control ineffective in ICU patients Pour assurer la livraison de ce courriel dans votre boîte de réception, veuillez ajouter [email protected] <mailto:[email protected]> à votre carnet de contacts. <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/French/Header.jpg> Intensive glucose control ineffective in ICU patients Clinical question Does tight control of blood glucose improve survival of patients in a medical surgical intensive care unit? Bottom line Tight control of blood glucose levels -- 80 mg/dL to 110 mg/dL (4.4-6.1 mmol/L) -- did not decrease mortality or other measured outcomes in patients admitted to an intensive care unit (ICU) with hyperglycemia. Hypoglycemia was much more common and was associated with an increased mortality. A meta-analysis has found similar results. (LOE = <http://mailer.cma.ca/t/4155251/234493/102001/0/> 1b) Reference Arabi YM, Dabbagh OC, Tamim HM, et al. <http://mailer.cma.ca/t/4155251/234493/4597965/0/> Intensive versus conventional insulin therapy: A randomized controlled trial in medical and surgical critically ill patients. Crit Care Med 2008;36(12):3190-3197. Study design Randomized controlled trial (nonblinded) Funding Foundation Allocation Concealed Setting Inpatient (ICU only) <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Obtenez <http://mailer.cma.ca/t/4155251/234493/4598439/0/> des crédits Mainpro <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Discutez <http://mailer.cma.ca/t/4155251/234493/4597967/0/> de cet InfoPOEM <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Archives <http://mailer.cma.ca/t/4155251/234493/145011/0/> <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Bilan <http://mailer.cma.ca/t/4155251/234493/177011/0/> des crédits <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Bullet.gif> Plus <http://mailer.cma.ca/t/4155251/234493/3021/0/> de FMC / DPC <http://mailer.cma.ca/t/4155251/234493/196001/0/> Publicité <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Book.gif> Bibliothécaire <http://mailer.cma.ca/t/4155251/234493/147004/0/> de l'AMC <http://www.cma.ca/multimedia/CMA/NewsLetters/InfoPOEMs/Envelop.gif> Envoyez-nous vos <mailto:[email protected]> commentaires Synopsis The Saudi Arabian investigators conducting this study enrolled 523 adults in a medical surgical ICU. The unit was closed and covered at all times by an intensivist. The patients (75% men) did not have type 1 diabetes, though 40% had a history of type 2 diabetes. The average blood glucose level was 194 mg/dL (10.8 mmol/L) in the intensive insulin group and 210 mg/dL (11.7 mmol/L) in the conventional insulin group. Most of the patients were nonoperative and were critically ill; 85% were mechanically ventilated and 65% were receiving vasopressors, with a mortality rate was approximately 15%. All patients received an infusion of regular insulin and were randomly assigned, using concealed allocation, to have their blood glucose maintained at 80 mg/dL to 110 mg/dL (4.4 - 6.1 mmol/L) in the intensive insulin group and 180 mg/dL to 200 mg/dL (10.0-11.1 mmol/L) in the conventional treatment group. Analysis was by intention to treat. The main outcome, in-ICU mortality, was not different between the 2 groups. At least one episode of hypoglycemia occurred in 28.6% of patients in the tight control group and 3.1% of patients in the conventional treatment group. In-ICU mortality was higher among those who had hypoglycemia (23.8% vs 13.7%; P = .02). There was no difference in in-hospital mortality, ICU or hospital length of stay, ventilation duration, infections, or the need for transfusion. These results are similar to those found in a previous meta-analysis (JAMA 2008;300(8):933-944). 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