New Cause of Critical Illness Hyperglycemia Identified

A new study has found that both peripheral insulin resistance and primary beta-cell dysfunction can cause critical illness hyperglycemia (CIH) in children.

Researchers from Emory University School of Medicine (Atlanta, GA, USA) conducted a prospective observational study of 41 critically ill children (aged 2 to 18 years) who were admitted to the pediatric intensive care unit (PICU). C-peptide and blood glucose levels were assessed in all children; patients who developed CIH--defined as persistent blood glucose (BG) above 7.7 mmol/l--were treated with insulin infusion to achieve BG levels between 4.4 and 7.7 mmol/l. C-peptide levels were compared with respect to CIH development and degree of organ failure in all patients.

Respiratory and cardiovascular failures were respectively defined as need for mechanical ventilation and need for vasoactive infusions. The researchers found that those with respiratory failure only had CIH caused by elevated insulin resistance, while those with both respiratory and cardiovascular failure had CIH caused by primary beta-cell dysfunction. The researchers also found that together with the etiologic differences, those patients with both respiratory failure and cardiovascular failure suffered from more severe CIH than those with respiratory failure alone. The study was published in the open access journal Critical Care, a publication of BioMed Central.

"Understanding the etiology of CIH may significantly impact disease course and therapeutic approach,” said coauthor Catherine Preissig, M.D. "Understanding these differences and elucidating the pathogenesis of CIH may assist in developing individualized glycemic goals and treatment strategies in children with life-threatening illness or injury.”

CIH is highly prevalent in pediatric critical illness, with approximately 20% of patients admitted to the PICU developing the condition.

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Emory University School of Medicine