Recent data showed that intensive insulin therapy (IIT) improved the mortality and morbidity in post-operative intensive care patients. IIT, bears the risk of hypoglycaemia, which might be associated with a decreased health related quality of life (HRQOL). We hypothesized that changes in HRQOL may be related to IIT.
All measured blood glucose values (BGs) in all patients admitted >48 hours to a 10-bed mixed IC from 2001 –2003 were retrospectively collected. Severe hypoglycemia (BG < 2.2 mmol/) and hypoglycemia (BG < 4.4 mmol/l) were defined. Patient data were divided in two groups: successful IIT group: patients with >75% of BGs in normal range, and no (severe) hypoglycemia at any time during IIT; unsuccessful IIT group: patients that did not fulfil the former criteria. HRQOL was assessed using the Short-Form (SF)-36. Patients or proxies completed this questionnaire in the first 48 hours of admission and 6 months thereafter.
Mean BG was 6,9 ± 1,5 mmol/l in the succesful group (N=45) and 8,7 ± 3,2 mmol/l in the unsuccesful group (N=286). In the succesful group, the percentage of patients with severe hypoglycemia and hypoglycemia was 3,3% and 31%, respectively. In the first group, scores in the physical functioning and general health domains decreased in the 6 month evaluation period (P = 0,003 and P<0,001, respectively). No changes were found in the role physical, vitality, pain, social functioning, role emotional; and mental health domains. In the unsuccessful IIT group, scores in the physical functioning, role physical and general health domains decreased in the same period (all P<0,001). No changes were observed in the vitality, pain, social functioning, role emotional, and mental health domains. No differences between the groups could be demonstrated with respect to scores in the HRQOL domains 6 months after ICU discharge.
HRQOL decreases after IC-treatment, particularly with respect to physical functioning and general health. This decrease was independent of successfulness of IIT.
The impact of ICU treatment on HRQOL is not influenced by IIT.
Peter Spronk, None.