Intensive Care Medicine

, Volume 37, Issue 3, pp 435–443

The metrics of glycaemic control in critical care

  • Iain M. J. Mackenzie
  • Tony Whitehouse
  • Peter G. Nightingale
Original

DOI: 10.1007/s00134-010-2103-2

Cite this article as:
Mackenzie, I.M.J., Whitehouse, T. & Nightingale, P.G. Intensive Care Med (2011) 37: 435. doi:10.1007/s00134-010-2103-2

Abstract

Introduction

Trials of tight glucose control have compared measures of central tendency, such as average blood glucose, and yielded conflicting results. Other metrics, such as standard deviation, reflect different properties of glucose control and are also associated with changes in outcome. It is possible, therefore, that the conflicting results from interventional studies arise from effects on glycaemic control that have not been reported.

Methods

Using glucose measurements from patients admitted to four adult intensive care units in one UK hospital, we sought to identify metrics of glycaemic control, examine the relationship between them and identify the metrics that are both independently and most strongly associated with outcome.

Results

We examined nine previously described metrics and identified a further four. Cluster analysis classified these metrics into two families, namely, those reflecting measures of central tendency and those reflecting measures of dispersion. A measure of minimum glucose was also identified but related to neither family. Plots of the quintiles of these metrics against hospital mortality revealed population-specific relationships. Areas under receiver-operating characteristic curves could not identify an optimum metric of central tendency or dispersion. Using odds ratios, we were able to show that the effect of these metrics is independent of one another.

Conclusion

Our results suggest that glycaemic control is associated with outcome on the basis of three independent metrics, reflecting measures of central tendency, measures of dispersion and a measure of minimum glucose.

Keywords

Blood glucoseMetricsCritical careAdultsPrognosis

Supplementary material

134_2010_2103_MOESM1_ESM.doc (1.1 mb)
Supplementary material 1 (DOC 1.06 MB)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Iain M. J. Mackenzie
    • 1
    • 3
  • Tony Whitehouse
    • 1
    • 3
  • Peter G. Nightingale
    • 2
  1. 1.Department of Anaesthesia and Critical Care Medicine, Queen Elizabeth HospitalUniversity Hospital Birmingham NHS Foundation Trust Edgbaston, BirminghamUK
  2. 2.Wellcome Trust Clinical Research Facility Queen Elizabeth Medical CentreBirminghamUK
  3. 3.Division of Medical SciencesUniversity of BirminghamEdgbaston, BirminghamUK