A systematic review and meta-analysis on glycemic control in traumatic brain injury.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical studies
PubMed 39141934 · doi:10.1016/j.clineuro.2024.108504
What was done
A systematic review and meta-analysis conducted according to PRISMA guidelines evaluating the role of glycemic control in traumatic brain injury. Searches were performed across PubMed, Embase, EBSCO Host, Scopus, ScienceDirect, Medline, and LILACS from inception through October 2020. Risk of bias was assessed using the GRADE quality scale.
What was found
Across 10 studies with 1,236 patients: - Intensive glycemic control showed no significant difference in mortality compared with conservative management (RR 0.99 [95% CI 0.81–1.21], p = 0.92). - Intensive glycemic control significantly reduced unfavorable clinical outcomes compared to standard management (RR 0.87 [95% CI 0.78–0.96], p = 0.007). - Intensive glycemic control significantly increased favorable clinical outcomes compared to standard neurocritical care (RR 1.19 [95% CI 1.02–1.38; reported as 1.02-138], p = 0.003).
Why it matters
These findings indicate that while tight glucose regulation does not decrease mortality following traumatic brain injury, it improves functional neurological recovery.
Limits
The literature search only covered studies through October 2020. The abstract does not specify whether included studies were randomized trials or observational cohorts, nor does it detail specific glucose thresholds, outcome definitions, or measured rates of hypoglycemia despite raising concern for silent hypoglycemic episodes.
Cited by
- supports Elevations in blood sugar following a significant brain injury are associated with worse clinical outcomes.