tailieunhanh - Báo cáo y học: "Patients with diabetes in the intensive care unit; not served by treatment, yet protected"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Patients with diabetes in the intensive care unit; not served by treatment, yet protected? | Siegelaar et al. Critical Care 2010 14 126 http content 14 2 126 CRITICAL CARE COMMENTARY L__ Patients with diabetes in the intensive care unit not served by treatment yet protected Sarah E Siegelaar J Hans Devries and Joost B Hoekstra See related research by Vincent etal. http content 14 1 R12 Abstract Diabetes is associated with severe complications and decreased life expectancy. However in the previous issue of Critical Care Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ICU despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality although the mechanisms are not yet fully understood. On the other hand patients with diabetes seem not to benefit from tight glycemic control during their ICU stay. Different treatment approaches may be needed for patients with diabetes and patients with stress hyperglycemia. As reported in the previous issue of Critical Care Vincent and colleagues 1 investigated the possible increased risk of patients with insulin-treated diabetes for morbidity and mortality in the intensive care unit ICU . Literature is conflicting at this point with studies showing increased risk 2 3 decreased risk 4 or neutral risk 5 6 . In their analyses Vincent and colleagues included 3 147 patients originally recruited for the Sepsis Occurrence in Acutely ill Patients SOAP study 7 including 226 patients with a prior diagnosis of insulin-treated diabetes. No significant differences in ICU or 28-day hospital mortality were observed between the groups even though patients with insulin-treated diabetes were sicker at baseline as reflected by higher Simplified Acute Physiology Score SAPS II and Sequential Organ Failure Assessment SOFA score. From a Cox proportional hazards analysis correcting for