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In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.
The proportion of discarded patients were 27% in the moderate hypoglycemia group, 21% in the severe hypoglycemia and 51% in the multiple hypoglycemic events groups.
We looked for moderate (2.2 to 3.3 mmol/L) and severe (<2.2 mmol/L) hypoglycemia, multiple hypoglycemic events (n ≥3) and the other main components of glycemic control (mean blood glucose level and blood glucose coefficient of variation (CV)).
The association of severe and moderate hypoglycemia and multiple hypoglycemic events with 90-day mortality was not different among the prespecified subgroup analyses (non-diabetic patients, computerized decision support systems and conventional glucose control), except for patients with diabetes.
As previously observed [ 11, 13, 14, 17, 28, 31], we observed a dose response relationship as severe hypoglycemia was associated with higher rates of death than was moderate hypoglycemia or the occurrence of multiple hypoglycemic events.
Comparable results were noted when considering patients with multiple hypoglycemic events (Table 1).> -wrap-foot>> -wraDataot> areta arexpresseded as mean (SD), median (25th to 75th interquartile range), and number.
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Patients with erratic daily glycemic excursions, progressive complications, and hypoglycemia unawareness are highly susceptible to multiple severe hypoglycemic events, at times life threatening.
When factors were examined independently, multiple significant relationships (age, co-morbidity, hypoglycemic events, and weight gain) with overall and/or domains of treatment satisfaction were found.
Potential cultural barriers to a more intensive insulin regimen in minorities also include: 1) a greater aversion to parenteral injections or to multiple injections; 2) greater fear of hypoglycemic events; 3) greater aversion to glucose monitoring; and 4) cultural barriers relating to images of wellness, such as a cultural aversion to public display of illness.
The study showed that intensive glycemic control initiated with gliclazide but maintained by adding multiple hypoglycemic agents as needed resulted in a nonsignificant 6% reduction of major macrovascular events (hazard ratio [HR] 0.94, 95% CI 0.84 1.06; P = 0.32).
At the same time, medical therapies containing multiple hypoglycemic strategies had always caused additional problems, regarding to low rates of adherence, high rates of side effects, and hypoglycemic events [ 24].
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