8591 Tight Blood Glucose Control In Patients With Diabetes In The Icu Does Not Decrease Mortality: A Systematic Review And Meta-Analysis

Abstract

Abstract Disclosure: M.L. Defante: None. B.X. Ximenes: None. B.A. Morais: None. O.C. Martins: None. V.M. Prizão: None. T.L. Correa: None. M.M. de Souza: None. Tight Blood Glucose Control in Patients with Diabetes in the ICU Does Not Decrease Mortality: A Systematic Review and Meta-Analysis Background: Dysglycemia is a common complication in critically ill patients admitted to the Intensive Care Unit (ICU). However, there is controversy among clinical trials and a lack of evidence for patients with diabetes on this matter. Therefore, we aimed to perform a meta-analysis comparing tight with liberal blood glucose control among patients with diabetes in the ICU. Hypothesis: Among patients with diabetes, tight blood glucose control is a safe option in the ICU to avoid hyperglycemia episodes. Methods: We searched PubMed, Cochrane Central, and EMBASE for studies comparing tight with liberal blood glucose control in critically ill patients with diabetes in the intensive care unit. The main outcome was mortality. Statistical analysis was performed using Review Manager 5.17 (Cochrane Collaboration) and RStudio 2023.12.0. Heterogeneity was assessed with I² statistics and Cochran's Q test. Quality assessment was performed with the Cochrane tool for assessing the risk of bias in randomized trials. Results: 6 randomized clinical trials with 3,775 patients were included. The frequency of mortality showed no statistically significant difference between patients under tight blood glucose control (385/1872; 20.56%) compared to those under liberal blood glucose control (345/1903; 18.12%) (OR 1.16; 95% CI 0.98-1.37; p= 0.09; I²= 0%). No further analysis was conducted due to a lack of outcome data for patients with diabetes in the trials. All studies were considered at low risk of bias. The funnel-plot showed no evidence of publication bias despite the small number of studies. Conclusion: The mortality outcome showed no statistically significant difference between the intervention and control groups. Observational studies suggest that hyperglycemia and hypoglycemia may have different physiological implications in patients with diabetes, making them poor markers of physiologic stress and risk of mortality. More randomized clinical trials are needed to make it possible to run more robust meta-analyses and clarify this clinical question. Presentation: 6/2/2024