The University of Melbourne
Austin Health; Melbourne Health; Northern Health; Peter MacCallum Cancer Centre; St Vincent’s Hospital Melbourne; Royal Women’s Hospital; Western Health
The Melbourne University Hospitals Group (Melbourne Health, Austin, St Vincent’s, Western and Northern hospitals), in collaboration with the Australian New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG), performed a pivotal multicentre randomised clinical trial to compare current treatment to a new approach, where blood glucose is treated only at a higher level in patients with diabetes. The aim was to determine whether hypoglycaemia (low blood glucose) and other complications are less, resulting in better patients outcomes with this new approach.
Expansion activities funded through the MRFF RART 2.2 Scheme include a nested cohort translational study testing the reliability of more accessible use point-of-care and continuous blood glucose monitoring. This will identify clinically important changes in blood sugar, enhancing broader community use of continuous and point-of-care testing.
This multicentre randomised clinical trial found that slightly elevated blood glucose levels helped to reduce the risk of experiencing dangerously low blood glucose levels, these often result in poor outcome in diabetic patients admitted to intensive care.
This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.
The project has provided support for current practice, while highlighting the risk that it increases the likelihood of hypoglycaemia. Which has previously been demonstrated to be harmful and is associated with increased mortality. This study has provided support for further research into approaches that reduce the incidence of hypoglycaemia, it also demonstrates that its feasible to conduct randomised trials of blood glucose control in critically ill patients with diabetes.
This project is the only randomised trial to explore a higher commencement point for the commencement of insulin in critically patients with diabetes, it will continue to inform future research and current practice in this patient population. The results will also most likely provide important information for any future guideline development.
- Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Biradar V, Doherty S, Eastwood G, Finfer S, French CJ, Ghosh A, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ and Deane AM; on behalf of the LUCID Study Investigators and the ANZICS Clinical Trials Group; 2020; Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial Critical Care and Resuscitation; Volume 22 (2), pages 133-141. PMID: 32389105
- Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Birardar V, Doherty S, Eastwood G, Finfer S, French CJ, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM; LUCID Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG). The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A multicenter, parallel-group, open-label, randomized clinical trial. Am J Respir Crit Care Med. 2022 May 24. doi: 10.1164/rccm.202202-0329OC. Epub ahead of print. PMID: 35608484