Intensive or liberal glucose control in intensive care units for septic patients? A meta-analysis of randomized controlled trials

Jiahao Meng; Xi Li; Yifan Xiao; Hang Tang; Pan Liu; Yumei Wu; Yilin Xiong; Shuguang Gao

doi:10.1016/j.dsx.2024.103045

Intensive or liberal glucose control in intensive care units for septic patients? A meta-analysis of randomized controlled trials

Diabetes Metab Syndr. 2024 May 23;18(5):103045. doi: 10.1016/j.dsx.2024.103045. Online ahead of print.

Authors

Jiahao Meng¹, Xi Li¹, Yifan Xiao¹, Hang Tang¹, Pan Liu¹, Yumei Wu¹, Yilin Xiong¹, Shuguang Gao²

Affiliations

¹ Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China.
² Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: gaoshuguang0341@csu.edu.cn.

PMID: 38796958
DOI: 10.1016/j.dsx.2024.103045

Abstract

Objective: To compare the clinical outcomes of intensive glucose control and liberal glucose control for septic patients in intensive care unit.

Methods: The databases of PubMed, Cochrane Library, Embase and Web of Science were searched systematically from inception to November 27, 2023 to identify trials involving a randomized comparison between intensive and liberal glucose control for septic patients in intensive care unit.

Results: A total of 14 randomized controlled trials involving 6226 patients were finally included. There was no statistically significant difference observed between intensive glucose control and liberal glucose control in terms of all-cause mortality, the need for renal replacement, vasopressor-free and mechanical ventilation-free days, and length of hospital stay. However, it is noteworthy that intensive glucose control exhibited a statistically higher risk of severe hypoglycemia (RR 2.66; 95%CI 1.85 to 3.83), need for blood transfusion (RR 1.12; 95%CI 1.01 to 1.23), and statistically prolonged length of stay in the ICU (MD 1.67; 95%CI 0.22 to 3.12) compared to liberal glucose control. Nevertheless, sensitivity analysis revealed that the need for blood transfusion and length of stay in the intensive care unit were not robust.

Conclusions: Both intensive and liberal glucose control had comparable effects on improving patient outcomes, but intensive glucose control carried a higher risk of severe hypoglycemia.

Keywords: Intensive care unit; Intensive glucose control; Liberal glucose control; Sepsis.