Tight Glycemic Control May Affect More than Just the Heart
We have pretty much been beat to death with the news that the ACCORD study was discontinued due to an increased incidence of heart disease in the tightly controlled glycemic group. For those of you who want to catch up on the ACCORD study, click here to to catch up on the details.
What is news here today is that intensive insulin therapy in the ICU may starve critically injured brains and potentially lead to further damage. A “brain energy crisis” was 23% more likely with each 1 mmol/L decrease in blood glucose and 10% more likely with each 1 unit/L increase of insulin infusion. The episodes of low blood brain glucose levels and high levels of metabolic disease distress markers were associated with a greater mortality risk and poorer neuro-outcomes as reported by the Society of Critical Care Medicine.
The trial was small, only 20 patients, but leads one to take home the following action points:
- The study does not support intensive insulin therapy in ICU patients with critical neurological injury
- Caution is needed in interpreting this study due to the small sample size and more study is needed to determine whether low brain glucose levels seen with tight glucose control lead to neurological harm
- These studies are only preliminary and have not been peer-reviewed
The ACCORD study and the study listed above leads one to wonder if tight glucose control IS warranted beyond what the American Diabetes Association currently recommends- a HbA1C of about 7%. Clearly, there are at least subgroups of populations where this may not be recommended.
About the Author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
burner responds:
Posted: March 27th, 2008 at 1:27 pm →
Nice read, you have a lot of interests and deserve every bit of success. Giving you 5 *****.Heart disease is one of the leading causes of death in most developed countries around the world, and the number of cases is rising constantly as a result of both modern lifestyles and increased overall longevity.