Thesefindings may inform the implementation of glycemic-control protocols selleck chem Afatinib in the intensivecare unit, as well as for the design of future interventional trials of intensivemonitoring and treatment of dysglycemia in the critically ill.Key messages? Diabetic status modulates the relation between the three domains ofglycemic control (hyperglycemia, hypoglycemia, and glycemic variability) and mortalityin critically ill patients in clinically important ways.? The range of mean BG from 80 to 140 mg/dl is associated with thelowest severity adjusted mortality among nondiabetes patients. In contrast, among thosewith diabetes, a mean BG of 80 to 110 mg/dl is associated with higher mortality riskthan is the range of 110 to 180 mg/dl.
? A single episode of hypoglycemia (BG <70 mg/dl) is independentlyassociated with increased risk of mortality among those without as well as those withdiabetes.? Increased glycemic variability, defined as CV >20%, isindependently associated with increased risk of mortality among those without, but notamong those with diabetes.AbbreviationsABG: arterial blood gas; APACHE: acute physiology and chronic health evaluation; BG:blood glucose; CV: coefficient of variation; DM: diabetes mellitus; ICU: intensive careunit; IIT: intensive insulin therapy; LOS: length of stay; OR: odds ratio.Participating centers in this investigation: AM: Amsterdam; AU: Austin; BC: BayCare; BI:Birmingham; GE: Geelong; OK: Okayama; ST: Stamford; TU: Tufts; VI: Vienna.Competing interestsDr. Krinsley reported receiving consultant fees from Medtronic Inc.
, Edwards LifeSciences, Roche Diagnostics, OptiScan Biomedical, and Alere and research support fromOptiScan Biomedical. He also received royalty payments for sales of ICU Tracker. Dr.Amin reported receiving speaker fees from BioMerueux. Ms. Maurer works as a consultantfor Alere, the distributor of ICU Tracker. Dr. Schultz reported receiving consultantfees from Medtronic Inc., GlySure Ltd., and Roche Diagnostics, and research support fromMedtronic Inc. and OptiScan Biomedical. Dr. van Hooijdonk reported consultant fees fromMedtronic Inc. and GlySure Ltd., and research support from Medtronic Inc. and OptiScanBiomedical. Dr. Annane reported serving on advisory board meetings for Edwards LifeSciences but did not receive compensation. Dr. Nasraway reported receiving consultantfees from GlySure Ltd.
, OptiScan Biomedical, and Edwards Life Sciences, and consultingfees and stock options from Echo Therapeutics. Dr. Holzinger reported receivingconsultant fees from Medtronic Inc. and speaker fees from NovoNordisk. Dr. Preiserreported receiving consultant fees from Medtronic Inc., Edwards Life Sciences, andOptiScan Biomedical.Dr. Egi, Dr. Kiss, Dacomitinib Dr. Amin, Dr. Schuetz, Dr. Kiyoshi, Dr. Mackenzie, Dr. Stow, Ms.Holewinski, Dr. Vincent, and Dr. Bellomo reported no relevant interests.