No clear benefits with tight glycaemic control in critically ill children
Tight glycaemic control (TGC) does not yield significant short-term survival gains and risk reductions for infections when compared with a conventional glucose-lowering strategy in critically ill patients in the paediatric intensive care unit, according to a meta-analysis.
Pooled data from five randomized controlled trials of TGC with insulin therapy vs conventional glucose monitoring (CGC) in a total of 3,933 critically ill children—including those who were severely burnt and who underwent cardiac surgery, among others—revealed that TGC had no significant effect on the primary outcome of 30-day mortality rates (odds ratio [OR], 0.99; 95 percent CI, 0.74–1.32; p=0.95). [Pediatr Res 2018;83:930-935]
Results were similar for the secondary outcome of healthcare-associated infections, with rates being slightly lower with TGC but not significantly different vs CGC (OR, 0.80; 0.64–1.00 p=0.05).
Additionally, hypoglycaemia occurred as a major complication of glucose control in all five trials. Children in the TGC group were six times as likely as those in the CGC group to develop the condition (OR, 6.37; 4.41–9.21; p<0.001).
No publication bias was detected among the studies.
The authors pointed out that although TGC may bring clinical benefits in theory, the strategy did not show obvious survival benefits compared with CGC in critically ill children. The null effect may be partially attributed to the heterogeneity of critical degrees of patients.
Meanwhile, the failure to reduce infection rates with TGC was probably due to the complicated condition of the children. “For example, insulin therapy may exert more obvious anti-inflammatory effect in obese or diabetic patients. Discrepancy [between] susceptibility to infection and different antibiotic regimens used in trials may also contribute to this result,” they added.
The results of the present meta-analysis should be interpreted with caution, given the heterogeneity of the included studies, the authors said. Additional investigations with long-term follow-up are also warranted to explore the association of TGC and hypoglycaemia with neurodevelopmental outcomes.