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Study: Benefits of improving blood sugar control in critically ill children

Improving blood sugar levels for critically ill children could save the NHS around £12 million each year, a major study has found. 

The study, published in the New England Journal of Medicine, included 1,369 children at 13 children's intensive care units across England. 

During the stress of severe illness or major surgery, blood glucose levels often rise to high levels, leading to 'stress hyperglycaemia'. 

Researchers compared the effect of allowing the natural rise in blood glucose to occur (conventional, or 'usual' management) to the effects of controlling the rise using insulin, to maintain normal glucose levels (tight glycaemic control). 

The researchers, from Royal Brompton & Harefield NHS Foundation Trust and the London School of Hygiene and Tropical Medicine found that there was a remarkable difference between the two groups at the one-year follow up. 

For children studied in intensive care who had not undergone heart surgery, tight glycaemic control shortened the average hospital stay by 13.5 days. However, the benefits were not seen for children who had undergone heart surgery. 

Study co-author Dr Richard Grieve from the London School of Hygiene and Tropical Medicine calculated that using tight glycaemic control for all children admitted to paediatric intensive care units (PICU) in England and Wales could save the NHS £12 million per year. 

He said: “While careful consideration should be given to the small increased risk in hypoglycaemia (low blood sugar), the potential benefits for children in going home sooner, and the release of hospital beds for other severely ill patients, would be significant.”

Lead author Dr Duncan Macrae, a consultant in children's intensive care at Royal Brompton & Harefield NHS Foundation Trust, added: “The findings of our study have important implications for the way blood glucose levels are managed in very sick children. Although we do not fully understand why controlling blood glucose levels during a child's most critical days leads to a quicker recovery, evidence from this study suggests that doctors caring for very sick children, who have not undergone heart surgery, should consider controlling blood glucose levels more closely during intensive care.

The study was funded by the National Institute for Health Research, and is available to download on the New England Journal of Medicine website.