Aggressive diabetes control in very ill questioned

CHICAGO (Reuters) - An analysis of recent diabetes studies debunks the notion that aggressive blood sugar control of critically ill hospital patients with diabetes can help save lives, U.S. researchers said on Tuesday.

The findings contradict results from a 2001 clinical trial of critically ill surgical patients that found tight glucose control reduced hospital deaths by one third.

That study led many professional societies to recommend aggressive treatment regimens to control blood sugar for these hospitalized patients with diabetes.

Glucose control has become a subject of significant debate among diabetes researchers after two major studies earlier this year arrived at conflicting conclusions about the benefits of lowering blood glucose to near normal levels in certain patients.

A North American study called Accord was halted earlier this year when researchers found that type-2 diabetics with heart risks who got intensive treatment to lower their blood sugar died at a higher rate than patients allowed higher blood sugar levels.

But a similar study in Australia called Advance showed that aggressive treatment reduced the risk of kidney disease by one-fifth without increasing the risk of death.

The new analysis, published in the Journal of the American Medical Association, focused specifically on aggressive glucose control in critically ill patients in hospital intensive care units.

Dr. Renda Soylemez Wiener of the Department of Veterans Affairs Medical Center in White River Junction, Vermont, and colleagues examined data from 29 studies involving 8,432 patients.

They found the number of patients who died in the hospital did not differ much between those whose glucose was managed aggressively with drugs and those who got normal care.

But aggressive glucose management was linked with a five times higher risk of hypoglycemia, a common side effect of diabetes treatment, in which blood sugar levels drop too low. Severe hypoglycemia can cause loss of consciousness.

"Given the overall findings of this meta-analysis, it seems appropriate that the guidelines recommending tight glucose control in all critically ill patients should be re-evaluated until the results of larger, more definitive clinical trials are available," the authors wrote.

In an accompanying commentary, Simon Finfer of the George Institute for International Health in Australia, which conducted the Advance study, said the analysis was based on flawed studies or ones that are inherently different.

"There is no simple or clear answer to the complex problem of glycemic control in critically ill adults; at present, targeting tight glycemic control cannot be said to be either right or wrong," Finfer and colleagues wrote.

(Reporting by Julie Steenhuysen; editing by Will Dunham and Mohammad Zargham)