Management of critically ill patients with type 2 diabetes: The need for personalised therapy

Table 4 Observational studies (diabetes as a binary variable) and outcomes related to hyperglycaemia (chronological order)

Ref.	Year	Study pts	Study point	Patients without diabetes	Patients with diabetes	Overall message
Rady et al[35]	2005	7285	Glycaemia vs hospital mortality	Inc mortality with blood glucose > 8 mmol/L	Inc mortality with blood glucose > 11.1 mmol/L	Mortality inc in non diabetics (10%) compared to diabetics (6%), (P < 0.01)
Whitcomb et al[23]	2005	2713	Admission hyperglycaemia (> 11.1 mmol/L) vs in-hospital mortality	Admission hyperglycaemia associated with inc mortality in CICU, CTICU and NSICU	Admission hyperglycaemia not associated with mortality	Mortality inc in non diabetics (10%) compared to diabetics (5%), (P < 0.05)
Krinsely[24]	2006	5365	Pre ITT and post ITT vs hospital mortality	Dec mortality risk with mean blood glucose 3.9-6.7 mmol/LInc mortality risk with mean blood glucose > 7.8 mmol/LMortality drop 19% (pre-ITT) to 14% (post-ITT), P < 0.01	Dec mortality risk with mean blood glucose 3.9-5.5 mmol/LInc mortality risk with mean blood glucose > 10.0 mmol/LNo statistically significant change in mortality pre and post ITT	Non-diabetics: 4.5-fold inc in mortality from lowest mean blood glucose, 3.9-5.5 mmol/L (9%) to highest, > 10mmol/L (40%)Diabetics: 2-fold inc in mortality from lowest mean blood glucose, 3.9-5.5 mmol/L (13%) to highest, > 10mmol/L (26%)
Egi et al[28]	2008	4896	Glycaemia vs mortality	Inc risk of ICU mortality with hyperglycaemia - with non survivors spending more time with blood glucose > 8.0 mmol/L	No association with hyperglycaemia and ICU mortality Lower OR of death at all levels of hyperglycaemia	Diabetic patients: lower ICU mortality (P = 0.02)No difference in hospital mortality between groups (P = 0.3)
Falciglia et al[26]	2009	259040	Glycaemia vs mortality	5-fold inc in mortality from lowest mean blood glucose, 3.9-6.1 mmol/L (8%) to highest, > 16.7 mmol/L (41%)	2-fold inc in mortality from lowest mean blood glucose, 3.9-6.1 mmol/L (6%) to highest, > 16.7 mmol/L (11%)	Hyperglycaemia associated with inc mortality in diabetics and non diabeticsMortality greater for hyperglycemic non diabetics patients
Stegenga et al[30]	2010	830	DM vs outcomes of sepsis	Admission hyperglycaemia (> 11.1 mmol/L) associated with inc 28 and 90 d mortality (P < 0.03)	Admission hyperglycaemia had no effect on diabetic mortaltity	Diabetes did not influence mortality in sepsis
Krinsley et al[32]	2013	44964	Hyperglycaemia, hypoglycaemia, and glycemic variability vs mortality (and how DM effects this)	Inc mortality with higher mean blood glucose (≥ 7.8 mmol/L)Dec mortality with lower blood glucose (4.4-7.8 mmol/L)	Inc mortality with mean blood glucose between 4.4-6.1 mmol/LDec mortality when blood glucose were higher (6.2-10 mmol/L)	Hyperglycaemia, hypoglycaemia, and increased glycemic variability are independently associated with mortality in ICU patientsDiabetic status tempers these relations

Inc: Increased; Dec: Decreased; CICU: Cardiac Intensive Care Unit; CTICU: Cardiothoracic Intensive Care Unit; NSICU: Neurosurgical Intensive Care Unit; ITT: Intensive insulin therapy.