Effect of different blood glucose target levels on the incidence of hypoglycemia during insulin therapy in the intensive care unit (在重症监护病房中使用胰岛素治疗后不同的血糖目标水平对低血糖发生率的影响)

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Prior to 2003, the target blood glucose level at our institute was <200 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>. This target was reassessed in 2004 and again in 2006 based on reports showing decreased mortality in patients with target glucose levels between 80 and 110 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content> and results from subsequent randomized controlled trials. The aim of the present study was to determine the incidence of hypoglycemia due to <jats:styled-content style="fixed-case">IIT</jats:styled-content>. The primary endpoint of the study was the incidence of hypoglycemia, with secondary outcomes of morbidity and mortality in three different periods.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A total of 2038 patients admitted to the intensive care unit (<jats:styled-content style="fixed-case">ICU</jats:styled-content>) were divided into three groups with different target blood glucose levels: Group <jats:styled-content style="fixed-case">H</jats:styled-content>, <200 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>; Group <jats:styled-content style="fixed-case">M</jats:styled-content>, <150 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>; and Group L, <120 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>. The incidence of hypoglycemia and patient outcomes in the three groups were compared.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The incidence of serious hypoglycemia (<40 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>) in Groups <jats:styled-content style="fixed-case">H</jats:styled-content>,<jats:styled-content style="fixed-case"> M</jats:styled-content> and <jats:styled-content style="fixed-case">L</jats:styled-content> was 3.5%, 4.0%, and 5.4%, respectively; the incidence of moderate hypoglycemia (<60 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>) was 9.4%, 11.7%, and 21.0% (<jats:italic><jats:styled-content style="fixed-case">P</jats:styled-content> </jats:italic>< 0.01), respectively. There were no significant differences among the groups in terms of days connected to the ventilator, length of <jats:styled-content style="fixed-case">ICU</jats:styled-content> stay and <jats:styled-content style="fixed-case">ICU</jats:styled-content> mortalities.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The incidence of moderate hypoglycemia (<60 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>) was significantly increased during the period when the target blood glucose level was <120 mg/d<jats:styled-content style="fixed-case">L</jats:styled-content>. Changes in target blood glucose levels did not affect patient mortality.</jats:p></jats:sec>