Accéder directement au contenu Accéder directement à la navigation
Article dans une revue

Individualised versus conventional glucose control in critically-ill patients: the CONTROLING study-a randomized clinical trial.

Julien Bohé 1, 2 Hassane Abidi 1, 2 Vincent Brunot 3 Amna Klich 2, 4 Kada Klouche 5, 6 Nicholas Sedillot 7 Xavier Tchenio 7 Jean-Pierre Quenot 8, 9, 10, 11, 12 Jean-Baptiste Roudaut 8 Nicolas Mottard 1, 2 Fabrice Thiollière 1, 2 Jean Dellamonica 13, 14 Florent Wallet 1, 2 Bertrand Souweine 15, 16 Alexandre Lautrette 15, 16 Jean-Charles Preiser 17 Jean-François Timsit 18, 19 Charles-Hervé Vacheron 1, 2 Ali Ait Hssain 15 Delphine Maucort-Boulch 2, 4
Abstract : Purpose: 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's pre-admission usual glycaemia, could improve outcome. Methods: 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 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 days. Results: 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 mg/dL) occurred in 3.9% of patients in the IC group and in 2.5% of patients in the CC group (p = 0.09). 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], p = 0.018). Conclusion: Targeting an ICU patient's pre-admission usual glycaemia using a dynamic sliding-scale insulin protocol did not demonstrate a survival benefit compared to maintaining glycaemia below 180 mg/dL.
Type de document :
Article dans une revue
Liste complète des métadonnées

https://hal.archives-ouvertes.fr/hal-03363013
Contributeur : Dominique Mornet Connectez-vous pour contacter le contributeur
Soumis le : samedi 2 octobre 2021 - 19:01:40
Dernière modification le : mardi 7 décembre 2021 - 14:00:04

Fichier

2021 Bohé et al., Individuali...
Fichiers produits par l'(les) auteur(s)

Identifiants

Citation

Julien Bohé, Hassane Abidi, Vincent Brunot, Amna Klich, Kada Klouche, et al.. Individualised versus conventional glucose control in critically-ill patients: the CONTROLING study-a randomized clinical trial.. Intensive Care Medicine, Springer Verlag, 2021, ⟨10.1007/s00134-021-06526-8⟩. ⟨hal-03363013⟩

Partager

Métriques

Consultations de la notice

118

Téléchargements de fichiers

56