Children with type 1 diabetes in intensive care show no benefit from tight blood sugar control

Benedict Jephcote
Wed, 31 May 2017
Children with type 1 diabetes in intensive care show no benefit from tight blood sugar control
Critically ill children with type 1 diabetes being treated in intensive care gain no better health outcomes from strict blood sugar control, a study has suggested.

The study was carried out because in 2014 there were about 20,000 children that were admitted to a pediatric ward in England. Young people with diabetes who are deemed critically ill can suffer from high blood sugar levels because of the stress of illness.

Previous studies that had looked at tight diabetes control in these cases had not shown an improvement in health outcomes in either adults or children so the researchers wanted to further investigate further.

Researchers recruited a total of 713 children with type 1 diabetes who had been admitted to pediatric intensive care units across 32 medical sites in the US and Canada.

They were split into two groups and were randomly assigned to receive different blood glucose targets. The group assigned to the tight control target would have their diabetes controlled to keep their blood sugar levels within 4.4 to 6.1 mmol/l where possible. The relaxed control group would aim to keep blood glucose levels between 8.3 and 10 mmol/l.

The children wore continuous glucose monitors to help with achieving the specified targets. The main outcome of the trial was to assess which group could spend the highest proportion of days outside of intensive care.

The findings showed that the different targets made no difference to the number of days the participants spent out of the intensive care unit. Furthermore, the study was stopped early because participants in the strict control group were experiencing too high a frequency of hypoglycemia and infections.

Currently, dedicated children's hospital wards have their own guidelines about monitoring blood sugar levels. Great Ormond Street Hospital recommends a child with diabetes should have their glucose levels checked every four hours. Intervention is recommended if levels do not fall between 4 and 7 mmol/l.

However, the researchers say that their recent findings indicate that target blood sugar levels for critically ill children with type 1 diabetes should be reviewed.

The study is published in the New England Journal of Medicine.
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