Hypoglycemia with intensive insulin therapy in critically ill patients: Predisposing factors and association with mortality

Abstract

OBJECTIVES: To examine the predisposing factors for hypoglycemia in medical-surgical intensive care unit patients treated with intensive insulin therapy and to assess its association with mortality. DESIGN: Nested-cohort study within a randomized controlled trial. SETTING: Tertiary care intensive care unit. PARTICIPANTS: Medical-surgical intensive care unit patients with admission blood glucose of >6.1 mmol/L or 110 mg/dL who were enrolled in a randomized controlled trial comparing intensive insulin therapy with conventional insulin therapy. INTERVENTIONS: None. EXPOSURE: Hypoglycemia was defined as blood glucose ≤2.2 mmol/L or 40 mg/dL and intensive care unit mortality was the primary outcome. MEASUREMENTS AND MAIN RESULTS: Among the 523 patients included in the study, hypoglycemia occurred in 84 (16%). Intensive insulin therapy was independently associated with increased risk of hypoglycemia (adjusted odds ratio, 50.65; 95% confidence interval, 17.36-147.78; p