Tight blood sugar control might not help all critically ill kids

January 8, 2014 by Amy Norton, Healthday Reporter
Tight blood sugar control might not help all critically ill kids
Study found no benefit with heart surgery patients, but those with other conditions were discharged earlier.

(HealthDay)—Children who are critically ill after having heart surgery do not benefit from having their blood sugar levels aggressively controlled, but some kids with other life-threatening conditions might, a new study suggests.

Experts said the findings, reported in the Jan. 9 issue of the New England Journal of Medicine, suggest that critically ill children should not routinely have their blood sugar tightly controlled.

But doctors might consider it for kids who have landed in the intensive-care unit for reasons other than , said study author Dr. Duncan Macrae. Macrae's team found that those children had a shorter hospital stay when they received insulin infusions to keep their blood sugar within normal range.

People who are critically ill or injured often develop very high blood sugar levels—what doctors call hyperglycemia. The condition is a response to stress and injury, said Macrae, a consultant in pediatric intensive care at the Royal Brompton and Harefield NHS Foundation Trust in London.

In the past, doctors did not aggressively treat hyperglycemia in , thinking it was natural and even helpful, Macrae said. But in 2001, a study of severely ill adults found that getting blood sugar levels down to normal decreased patients' risk of dying or developing certain complications, such as kidney failure.

Not all studies since have found a benefit, however, and there's been much less known about the effects in children.

Doctors aren't sure that itself directly increases critically ill patients' risk, said Dr. Michael Agus, of Boston Children's Hospital, who wrote an editorial published with the study.

"Hyperglycemia may merely be indicative of severe physiological stress," and not necessarily the cause of complications, Agus said.

The only way to figure it all out, Agus said, is to do clinical trials, like the current one.

For the study, Macrae's team focused on nearly 1,400 children being treated in ICUs at 13 different hospitals in England. Sixty percent had undergone heart surgery, while the rest had landed in the ICU for other reasons, such as a severe head injury or blood infection.

Roughly half of the children were randomly assigned to "conventional" , which involved infusions of insulin only when sugar levels went above a certain level. The other children received tight blood sugar control, with insulin infusions that were continuously adjusted to keep sugar levels in the normal range.

In the end, the intensive therapy did not improve children's survival odds: 5 percent of kids in each group died within 30 days.

But when the researchers dug deeper, they found that among children who had not undergone heart surgery, those on tight blood sugar control got out of the hospital faster—two weeks sooner, on average.

Agus suggested a potential explanation for the difference between the two groups: Children not having heart surgery seemed to be more critically ill, and might have had more to gain from tight blood sugar control, he said.

Children having heart surgery are in fairly stable condition going in, and the course of their recovery is more predictable, Agus said. But children who land in the ICU because of accidents or a sudden illness are generally in less stable condition.

Macrae said the reasons for the shorter hospital stay are not clear. But the findings suggest that, for children who have not had heart surgery, doctors should consider tight blood sugar control, he said.

Agus was more cautious. He said the best course for those critically ill kids "remains an open question," and ongoing studies should help find an answer.

The major risk from tight blood sugar control is hypoglycemia, in which drop too low, Macrae said.

Hypoglycemia can also be dangerous, potentially causing complications such as seizures and brain damage. In this study, 7 percent of children on tight blood developed severe hypoglycemia, versus just 1.5 percent in the comparison group.

Agus said doctors need to feel confident that the benefits of intensive insulin therapy outweigh the risks of lowering too much.

More broadly, he said the new trial underscores the importance of studying treatments in children, rather than relying on results in adults. "It would be a big mistake to simply take findings in adults and apply them to all critically ill children," Agus said.

As this study shows, even different groups of might respond differently to a therapy, he said.

Explore further: Tight glycemic control has no proven benefits for children in the cardiac ICU

More information: The Nemours Foundation has more on pediatric intensive care.

Related Stories

Tight glycemic control has no proven benefits for children in the cardiac ICU

September 8, 2012
Although some studies have portrayed tight blood sugar control as a potential means of lowering infection rates in critically ill adults, a new study—led by principal investigator Michael Agus, MD, director of the Medicine ...

Tight blood sugar control for pediatric cardiac surgery patients does not improve outcomes

September 10, 2012
Tight blood sugar control in the intensive care unit for pediatric cardiac surgery patients does not improve patients' infection rate, mortality, length of stay or organ failure when compared to standard care, new research ...

Computer program aids blood-sugar control among critically ill

June 25, 2012
A computer-software program more effectively controlled blood-sugar levels among critically ill patients than nurse-directed care did, according to the first large clinical trial of its kind. The results to be presented at ...

Severe low blood sugar occurs often in patients with Type 2 diabetes

July 30, 2013
Patients with diabetes who take certain types of medications to lower their blood sugar sometimes experience severe low blood sugar levels, whether or not their diabetes is poorly or well controlled, according to a new study ...

Diabetic kids can still enjoy Christmas treats if parents take special care

December 11, 2013
Indulgences abound during the holidays—from family gatherings to parties with friends and even stockings stuffed with goodies from Santa. For children with diabetes, overindulging on the delicacies of the season could result ...

Researchers explore how mothers' blood sugar levels influence child fat

December 12, 2013
Researchers from Manchester have begun a new study to determine whether blood sugar levels during pregnancy, lower than the level used to diagnose gestational diabetes, influences later levels of body fat in children and ...

Recommended for you

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

Safety of medical devices not often evaluated by sex, age, or race

July 25, 2017
Researchers at Yale and the University of California-San Francisco have found that few medical devices are analyzed to consider the influence of their users' sex, age, or race on safety and effectiveness.

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.