Personalised Treatment for Patients in ICU with Type 2 Diabetes
The Liberal Glucose Control in critically ill patients with pre-existing type 2 Diabetes (LUCID) trial is one of several MACH supported projects aimed at increasing effective management and treatment of diabetes funded through the Australian Government's MRFF RART scheme.
Launched in 2019 and led by Associate Professor Adam Deane and Mr Alexis Poole, this trial will investigate whether treatment should be ‘personalised’ for critically ill patients with pre-existing type 2 diabetes and whether there is an optimum glucose concentration target in this group. It is hoped that results will be published later this year and that the outcomes will be translatable to care in all Intensive Care Units (ICUs) across Australia.
The latest from the LUCID study
“We were able to include 423 patients in this trial,” says Associate Professor Deane. “Study participants were randomised to receive the usual care that all patients receive in the ICU, or a more liberal approach to the treatment of their blood sugar.
“When in ICU, the blood sugar level of all patients increases, and this is exacerbated in patients with pre-existing diabetes. The rationale underlying this trial is that we currently have the same blood sugar targets for everybody regardless of whether they had diabetes or not. We wondered whether this was the wrong thing to do, because what might be okay for a patient who was very sick and never had an issue with high blood sugar levels may actually be too low for a patient with pre-existing diabetes who are now critically ill in the ICU.”
Mr Alexis Poole is as an Intensive Care Nurse who is conducting this trial for his PhD under the supervision of Associate Professor Deane. Mr Poole will be the first author on the paper when it is published early next year. Once the results have been made public, he will take the opportunity to build on them and conduct further post-doctoral research.
“It’s been a great opportunity to get involved in such a large prominent trial for my PhD,” says Mr Poole.
The evolution of the study
“The journey began at the Royal Adelaide Hospital when Adam and I worked together. We began collaborating, which resulted in the preliminary work for LUCID. I diversified and ended up conducting research to inform the clinical work I provide.
“Our early work led us to believe that there would be benefits in using different target glucose to give us more control in ICU for patients who have Type 2 Diabetes. Funded by the MACH Grant, the LUCID trial allowed us to conduct a larger trial to test that hypothesis.
“We’re looking at a slightly different target range for patients who have Type 2 Diabetes when they come into ICU. Currently we manage everyone the same, regardless of whether they have diabetes or not. We suspect that having diabetes may require us to modify our treatments.”
What does the trial propose?
“Our intervention, trying to marginally alter the blood sugar targets, may seem relatively modest,” says Associate Professor Deane.
“We are allowing individual hospitals to try and get to that target how they best see fit. There is always variation between hospitals and treatments but the beauty of doing pragmatic randomised controlled trials at a large number of centres is that the results represent what happens if implemented in real life.
“We tried to integrate treatment to expand our understanding of the mechanism underlying any effect that might occur. In order to do this, we needed to collect detailed and continuous data from a proportion of the patients in this trial. The second round of RART funding (RART 2.2) allowed us to expand our data collection to obtain this information.”
Partners in the study
The two rounds of funding since 2019 have seen collaboration across the Royal Melbourne Hospital, Austin Health, Western Health, St Vincent’s and the Northern Hospital.
“All up we had 16 ICUs across Australia and New Zealand enrolling patients into the study, with a broad representation across MACH partners,” says Mr Poole.
“We had an especially close relationship with Western Health, Sunshine Hospital and the Royal Melbourne Hospital during the latest iteration of the study, where some of our patients were admitted with COVID.
“We were also able to develop our partnerships with St Vincent’s and Austin Health, who participated in the development and conduct of this trial.”
The LUCID study is also endorsed by the Australian and New Zealand Clinical Trials Group, which means most of the ICUs around Australia and New Zealand are keen to participate.
What the future holds
“Now the studies have been completed, we’re collecting and verifying all data,” says Mr Poole.
“We hope to have finalised everything and be able to publish the results early next year. We think that the results will have a pretty big implication on how aspects of care are provided for patients with diabetes.
“Whatever the results are, they’ll be representative of the broader hospital community,” says Associate Professor Deane. “If there is a benefit observed in ICU it will support the idea that the intervention is probably going to be beneficial for patients across the hospital. It’s perhaps safer in the ICU to aggressively lower blood sugar levels, whereas outside of ICU there is less monitoring and it is more difficult to try and prevent harm from occurring. If we see a signal of benefit in the ICU for a liberal approach it is probable that any benefit would be increased on the hospital wards.”
Mr Poole agrees: “In ICU it’s more of a controlled environment to test that theory. Blood tests are generally more regular, and there’s more opportunities to prevent episodes of low blood sugar levels from too much insulin.”
We look forward to hearing more from Associate Professor Deane and Mr Poole once the results of the LUCID study are published early next year. Read more on the LUCID study project page.
This project was supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.