The impact of glycemic control on clinical outcomes of diabetic patients in the intensive care unit (ICU)

• Grant number: 24/19652-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: March 01, 2025
• End date: February 28, 2026
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Érika Bevilaqua Rangel
• Grantee: Rafael Soares Simoneti
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

Diabetes mellitus (DM) is a chronic disease resulting in macrovascular and microvascular complications. It affects several vital organs, such as the brain, kidneys, and heart. Various complications, such as stroke, chronic kidney disease, heart disease, peripheral vascular insufficiency, and neuropathy, are frequently present in patients with type 2 DM (T2DM), contributing to higher cardiovascular mortality compared to non-diabetic patients.Hyperglycemia in DM is associated with increased inflammation and production of reactive oxygen species, leading to damage in the microvasculature, especially in the kidneys. Acute kidney injury (AKI) in patients with DM increases the risk of hypoglycemia and mortality, highlighting the complexity of glycemic management in critically ill patients with this condition.In critically ill patients, DM is highly prevalent, affecting up to 25% of the population. Studies indicate that critically ill diabetic patients with hyperglycemia may present lower morbidity and mortality rates compared to non-diabetic patients with hyperglycemic conditions. However, the NICE-SUGAR study demonstrated that tight glycemic control in critically ill patients was associated with higher mortality due to the risk of hypoglycemia, suggesting that less strict glycemic control may be more beneficial.Recently, the LUCID clinical trial compared different glycemic control targets in critically ill patients with T2DM. The study showed that a less strict approach reduced the incidence of hypoglycemia, but there was no significant improvement in clinical outcomes compared to stricter control. The proposed study aims to analyze data from diabetic patients in the ICU of Hospital São Paulo to better understand the impact of glycemic control on clinical outcomes, contributing to more effective treatment strategies for critically ill patients with DM.