Critically ill patients undergoing surgery often have a rise in blood sugar and a drop in insulin levels, a stress reaction that can lead to complications, such as increased risk of infection and organ dysfunction. Some studies suggest that tightly controlling blood sugar with insulin infusions may reduce mortality and improve recovery in these very sick patients. But this treatment comes with a risk of severe hypoglycemia, and critical care physicians have been reluctant to try it in children.
Despite the risk, Michael Agus, MD, Director of the Medicine Critical Care Program at Children's, felt that if done safely, controlling glucose levels could boost recovery and enhance neurologic development in infants in the cardiac intensive care unit. "Parents are under a lot of stress and not interested in a study that could put their child at risk," he says.
Both an endocrinologist and intensive care doctor by training, Agus spent years helping to develop and test various continuous glucose monitors, adapted from those used in diabetes, which sound an alarm when infants' glucose levels change. By using this device, he has launched the most controlled and safest glucose clinical trial to date, involving babies who have undergone cardiac surgery at Children's and the University of Michigan.
To date, they've enrolled 320 cardiac ICU patients, with a goal of 1,000 by 2011. So far, hypoglycemia rates are a mere 3.5 percent, drastically lower than those in any other trial, and even lower than pre-trial rates. In the future, Agus hopes to follow the health and neurodevelopment of these children and extend the glucose control trial to all ICU patients.