Alexis P Poole1, James Anstey2, Rinaldo Bellomo3, Vishwanath Biradar4, Adam M Deane2, Simon R Finfer5, Mark E Finnis6, Craig J French7, Palash Kar8, Peter S Kruger9, Matthew J Maiden10, Johan Mårtensson3, Colin J McArthur11, Shay P McGuinness12, Paul J Secombe13, Antony E Tobin14, Andrew A Udy15, Glenn M Eastwood3. 1. Discipline of Acute Care Medicine, University of Adelaide, Australia; Department of Intensive Care, Royal Adelaide Hospital, Australia. Electronic address: Alex.Poole@sa.gov.au. 2. Department of Intensive Care, Royal Melbourne Hospital, Australia. 3. Department of Intensive Care, Austin Hospital, Australia. 4. Department of Intensive Care, Lyell McEwin Hospital, Australia. 5. The George Institute for Global Health, University of New South Wales, Sydney, Australia. 6. Department of Intensive Care, Royal Adelaide Hospital, Australia. 7. Department of Intensive Care, Western Health, Australia. 8. Discipline of Acute Care Medicine, University of Adelaide, Australia; Department of Intensive Care, Royal Adelaide Hospital, Australia. 9. Department of Intensive Care, Princess Alexandra Hospital, Australia; School of Medicine, University of Queensland, Australia. 10. Department of Intensive Care, Geelong Hospital, Australia. 11. Department of Critical Care Medicine, Auckland District Health Board, Australia. 12. Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Auckland District Health Board, Australia. 13. Department of Intensive Care, Alice Springs Hospital, Australia. 14. Department of Intensive Care, St Vincent's Hospital, Melbourne, Australia. 15. Department of Intensive Care, The Alfred Hospital, Australia.
Abstract
BACKGROUND: Approximately 9000 patients with type-2 diabetes mellitus (T2DM) are admitted to an intensive care unit (ICU) in Australia and New Zealand annually. For these patients, recent exploratory data suggest that targeting a more liberal blood glucose range during ICU admission may be safe and potentially beneficial. However, the current approach to blood glucose management of patients with T2DM in Australia and New Zealand ICUs is not well described, and there is uncertainty about clinician equipoise for trials of liberal glycaemic control in these patients. AIM: The aim is to describe self-reported blood glucose management in patients with T2DM by intensivists working in Australian and New Zealand ICUs and to establish whether equipoise exists for a trial of liberal versus standard glycaemic control in such patients. METHOD: An online questionnaire of Australia and New Zealand intensivists conducted in July-September 2016. RESULTS: Seventy-one intensivists responded. Forty-five (63%) used a basic nomogram to titrate insulin. Sixty-six (93%) reported that insulin was commenced at blood glucose concentrations >10 mmol/L and titrated to achieve a blood glucose concentration between 6.0 and 10.0 mmol/L. A majority of respondents (75%) indicated that there was insufficient evidence to define optimal blood glucose targets in patients with T2DM, and 59 (83%) were prepared to enrol such patients in a clinical trial to evaluate a more liberal approach. CONCLUSION: A majority of respondents were uncertain about the optimal blood glucose target range for patients with T2DM and would enrol such patients in a comparative trial of conventional versus liberal blood glucose control.
BACKGROUND: Approximately 9000 patients with type-2 diabetes mellitus (T2DM) are admitted to an intensive care unit (ICU) in Australia and New Zealand annually. For these patients, recent exploratory data suggest that targeting a more liberal blood glucose range during ICU admission may be safe and potentially beneficial. However, the current approach to blood glucose management of patients with T2DM in Australia and New Zealand ICUs is not well described, and there is uncertainty about clinician equipoise for trials of liberal glycaemic control in these patients. AIM: The aim is to describe self-reported blood glucose management in patients with T2DM by intensivists working in Australian and New Zealand ICUs and to establish whether equipoise exists for a trial of liberal versus standard glycaemic control in such patients. METHOD: An online questionnaire of Australia and New Zealand intensivists conducted in July-September 2016. RESULTS: Seventy-one intensivists responded. Forty-five (63%) used a basic nomogram to titrate insulin. Sixty-six (93%) reported that insulin was commenced at blood glucose concentrations >10 mmol/L and titrated to achieve a blood glucose concentration between 6.0 and 10.0 mmol/L. A majority of respondents (75%) indicated that there was insufficient evidence to define optimal blood glucose targets in patients with T2DM, and 59 (83%) were prepared to enrol such patients in a clinical trial to evaluate a more liberal approach. CONCLUSION: A majority of respondents were uncertain about the optimal blood glucose target range for patients with T2DM and would enrol such patients in a comparative trial of conventional versus liberal blood glucose control.