{"id":20608,"date":"2021-11-13T05:05:00","date_gmt":"2021-11-12T21:05:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20608"},"modified":"2021-11-13T21:51:26","modified_gmt":"2021-11-13T13:51:26","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e7%9a%84%e4%b8%aa%e4%bd%93%e5%8c%96%e4%b8%8e%e4%bc%a0%e7%bb%9f%e8%a1%80%e7%b3%96%e6%8e%a7","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20608","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u8bba\u6587]\uff1a\u5371\u91cd\u75c5\u60a3\u8005\u7684\u4e2a\u4f53\u5316\u4e0e\u4f20\u7edf\u8840\u7cd6\u63a7\u5236"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Individualised versus conventional glucose control in critically-ill patients: the CONTROLING study\u2014a randomized clinical trial<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Julien Boh\u00e9,\u00a0Hassane Abidi,\u00a0Vincent Brunot,\u00a0et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Intensive Care Med <a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-021-06526-8#article-info\">Published:\u00a0<time datetime=\"2021-09-29\">29 September 2021<\/time><\/a><\/h3>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Abs1\">Abstract<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Purpose<\/h3>\n\n\n\n<p>Hyperglycaemia is an adaptive response to stress commonly observed in critical illness. Its management remains debated in the intensive care unit (ICU). Individualising hyperglycaemia management, by targeting the patient\u2019s pre-admission usual glycaemia, could improve outcome.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Methods<\/h3>\n\n\n\n<p>In a multicentre, randomized, double-blind, parallel-group study, critically-ill adults were considered for inclusion. Patients underwent until ICU discharge either individualised glucose control by targeting the pre-admission usual glycaemia using the glycated haemoglobin A1c level at ICU admission (IC group), or conventional glucose control by maintaining glycaemia below 180&nbsp;mg\/dL (CC group). A non-commercial web application of a dynamic sliding-scale insulin protocol gave to nurses all instructions for glucose control in both groups. The primary outcome was death within 90&nbsp;days.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Results<\/h3>\n\n\n\n<p>Owing to a low likelihood of benefit and evidence of the possibility of harm related to hypoglycaemia, the study was stopped early. 2075 patients were randomized; 1917 received the intervention, 942 in the IC group and 975 in the CC group. Although both groups showed significant differences in terms of glycaemic control, survival probability at 90-day was not significantly different (IC group: 67.2%, 95% CI [64.2%; 70.3%]; CC group: 69.6%, 95% CI [66.7%; 72.5%]). Severe hypoglycaemia (below 40&nbsp;mg\/dL) occurred in 3.9% of patients in the IC group and in 2.5% of patients in the CC group (<em>p<\/em>\u2009=\u20090.09). A post hoc analysis showed for non-diabetic patients a higher risk of 90-day mortality in the IC group compared to the CC group (HR 1.3, 95% CI [1.05; 1.59],&nbsp;<em>p<\/em>\u2009=\u20090.018).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-021-06526-8\/MediaObjects\/134_2021_6526_Fig1_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-021-06526-8\/MediaObjects\/134_2021_6526_Fig2_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-021-06526-8\/MediaObjects\/134_2021_6526_Fig3_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Conclusion<\/h3>\n\n\n\n<p>Targeting an ICU patient\u2019s pre-admission usual glycaemia using a dynamic sliding-scale insulin protocol did not demonstrate a survival benefit compared to maintaining glycaemia below 180&nbsp;mg\/dL.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Individualised versus conventional glucose control in c [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20608"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20608"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20608\/revisions"}],"predecessor-version":[{"id":20609,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20608\/revisions\/20609"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}