Lancet Glob Health 2020; 8: e154654. doi: 10.1016/S2214-109X(20)30388-0
Hypoglycemia is associated with increased mortality in severely sick children. WHO recommends treatment of hypoglycemia for a blood glucose < 2.5 mmol/l The authors hypothesized that increasing the threshold for the treatment of hypoglycemia from 2.5 to 5 mmol/l would reduce all cause in-hospital mortality Analysis of the trial results after enrolment of 28% of the participants showed no difference in mortality between children with a baseline glycemia between 2.5 and 5 mmol/l receiving standard treatment and those receiving the tested hypoglycemia management
The cut off blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/l) is not evidence-based. The authors previously showed that mortality in severely ill children with low blood glucose concentrations is higher than in those with normoglycaemia. This observation served as a basis for their hypothesis that increasing the threshold for treatment of hypoglycemia from 2.5 to 5.0 mml/l might decrease mortality in very sick children. However, the results of this randomized, controlled trial performed in children aged 1 month to 5 years do not support this hypothesis. This strongly suggests that hypoglycemia between 2.5 and 5.0 mmol/l is merely a marker of severity of the disease but that it does not cause death. Low blood glucose concentrations may reflect chronically poor feeding, insufficient secretion of or resistance to counterregulatory hormones, low fat stores or other pathophysiological mechanisms. Understanding these determinants will be a first step in proposing novel approaches for the treatment of severely sick children in low resource settings.