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Tight Control in the Hospital Questioned

Tara Dairman

August 29, 2008

A new analysis of multiple studies has found that tight blood glucose control (keeping blood glucose levels as close to normal as possible) does not reduce the risk of dying in the hospital in people who are critically ill.

In a meta-analysis (analysis of data from several clinical trials) published in The Journal of the American Medical Association on August 27, researchers looked at 29 studies with a total of 8,432 participants. Their analysis found a 21.6% rate of death among people who had been on tight blood glucose control during their hospital stays and a 23.3% death rate among those receiving usual care—not a significant difference.

Further analyses of data from some of the trials found no significant difference between the groups in risk for needing to start dialysis. People on tight control did, however, experience a significantly decreased risk of septicemia (illness due to bacteria in the blood)—10.9% in people with tight control vs. 13.4% of people receiving usual care. But people on tight control also had five times the risk of hypoglycemia—13.7% vs. 2.5%.

Commenting on their findings, the researchers suggested that “the guidelines recommending tight glucose control in all critically ill patients should be reevaluated until the results of larger, more definitive clinical trials are available.” But in a separate editorial, researchers not involved in this study commented that studies included in this meta-analysis or the meta-analysis itself may have been flawed. They also said that research is needed to see if tight control reduces death rates in the hospital under optimal conditions before a conclusion can be made.

Have you had experience with tight control of your blood glucose levels in the hospital? Do you think this affected your recovery? Share your thoughts with a comment below.



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