Patients in intensive care units who have even modest hyperglycemia may have a significantly increased risk for death, according to an article in the December issue of Mayo Clinic Proceedings. The findings were based on data for 1,826 intensive care unit patients with a wide range of medical and surgical diagnoses.

Even a modest degree of hyperglycemia was associated with a substantial increase in deaths in patients, said author James Krinsley, MD. He noted that hyperglycemia is common in critically ill adults and that standard clinical practice is to tolerate a moderate degree of hyperglycemia in these patients. However, Krinsley believes that the findings from this study suggest a new approach to glucose management in the intensive care unit and should prompt additional studies.

“Although hyperglycemia can be a marker of severity of illness, it may also worsen outcomes,” Krinsley said. “We think that tight glucose control results in improved vascular function and lower risk of infection.”

In the current study, data were reviewed for 1,826 patients whose glucose values were obtained in intensive care units at a single center between October 1, 1999, and April 4, 2002. The lowest death rates occurred in patients whose average glucose levels were in the lower end of the normal range. Death rates increased as the average glucose levels increased. This association was noted among people with and without diabetes.

Based on these findings, the research team has developed a protocol for intensive monitoring and treatment of glucose levels of patients admitted to the critical care unit. The team is studying whether tighter management of glucose levels in the intensive care unit will result in lower death rates and lower organ system dysfunction. Those results may be published soon.

An editorial by Douglas Coursin, MD, and Michael Murray, PhD., MD, suggests that randomized controlled studies of a broader range of patients need to be done to allow for analysis of subsets of patients, including critically ill adult and pediatric patients with various types of diagnoses, as well as patients with known cardiovascular disease and patients with type I or type II diabetes.