No Benefit of Tight Glycemic Control in Critically Ill Children

Tight glycemic control—with a blood glucose target of 80 to 110 mg/dL—does not improve outcomes for critically ill children, concludes a trial in The New England Journal of Medicine.

The randomized, multicenter trial included 713 critically ill children with confirmed hyperglycemia, excluding cardiac surgery patients. Patients were assigned a target blood glucose range of 80 to 100 mg/dL (tight glycemic control) or 150 to 180 mg/dL. The study included continuous glucose monitoring with explicitly guided insulin adjustments. The main outcome of interest was number of ICU-free days up to day 28.

Recruitment was halted at 50% enrollment when data and safety monitoring suggested a low chance of benefit plus evidence of possible harm. On intention-to-treat analysis, median number of ICU-free days was about 19 in both groups. Secondary outcomes—including mortality, severity of organ dysfunction, and ventilator-free days—were similar as well.

Evidence of harm in the tight glycemic control group included an increased risk of healthcare-associated infections: 3.4% versus 1.1%. Patients assigned to the lower glucose target were also at higher risk of severe hypoglycemia (less than 40 mg/dL): 5.2% versus 2.0%.

Previous studies have found no clinical benefit of tight glycemic control in critically ill adults or in children after cardiac surgery. The new results find no improvement in outcomes with a blood glucose target of 80 to 110 mg/dL in critically ill children without cardiac surgery. Tight control may also increase the risk of adverse outcomes, including hypoglycemia and catheter-associated bloodstream infections [Agus MSD, et al. Tight glycemic control in critically ill children. N Engl J Med. January 24, 2017; DOI: 10.1056/NEJMoa1612348017].