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Trial registered on ANZCTR
Registration number
ACTRN12615001164583
Ethics application status
Approved
Date submitted
28/09/2015
Date registered
2/11/2015
Date last updated
23/04/2021
Date data sharing statement initially provided
27/11/2018
Date results provided
23/04/2021
Type of registration
Prospectively registered
Titles & IDs
Public title
Stress hyperglycaemia and mortality in critical illness
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Scientific title
Single-centre, observational trial of stress hyperglycaemia and in-hospital mortality in adult patients admitted to intensive care
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Secondary ID [1]
287545
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Nil
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Universal Trial Number (UTN)
Nil
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
hyperglycaemia
296316
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critical illness
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Condition category
Condition code
Metabolic and Endocrine
296594
296594
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0
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Diabetes
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Public Health
296714
296714
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0
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Health service research
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Stress hyperglycaemia ratio as defined by the admission blood glucose level divided by the estimated average glycaemia. Estimated average glycaemia will be computed from the HbA1c using the formula as suggested by Nathan, D.M. et al. Diabetes Care 31, 1473–8 (2008). The patients will have routine intensive care. Bloods needed for testing (e.g. for HbA1c) are those already drawn during routine intensive care and added retrospectively if not already ordered in standard care. The patients will be followed up until hospital discharge.
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Intervention code [1]
292943
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Not applicable
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Comparator / control treatment
admission glucose concentration by blood sample performed as part of standard care for admission into intensive care.
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Control group
Active
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Outcomes
Primary outcome [1]
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all-cause mortality
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Assessment method [1]
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Timepoint [1]
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in-hospital admission
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Secondary outcome [1]
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Composite: major adverse cardiac events, acute renal injury (by KDIGO criteria), all-cause mortality, nosocomial infection, neurological complication (stroke or transient ischaemic attack) as assessed by review of hospital records, imaging results and laboratory results.
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Assessment method [1]
317813
0
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Timepoint [1]
317813
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in-hospital admission
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Secondary outcome [2]
317821
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major adverse cardiac events as assessed by review of hospital records and laboratory results.
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Assessment method [2]
317821
0
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Timepoint [2]
317821
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in-hospital admission
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Secondary outcome [3]
317822
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acute renal injury (by KDIGO criteria) as assessed by review of hospital records and laboratory results.
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Assessment method [3]
317822
0
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Timepoint [3]
317822
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in-hospital admission
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Secondary outcome [4]
317823
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nosocomial infection as assessed by review of hospital records and laboratory results.
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Assessment method [4]
317823
0
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Timepoint [4]
317823
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in-hospital admission
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Secondary outcome [5]
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neurological complication (stroke or transient ischaemic attack) as assessed by review of hospital records, laboratory results and imaging results.
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Assessment method [5]
317824
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Timepoint [5]
317824
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in-hospital admission
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Secondary outcome [6]
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length of stay as assessed by review of hospital records.
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Assessment method [6]
317825
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Timepoint [6]
317825
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in-hospital admission
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Eligibility
Key inclusion criteria
admission to intensive care unit within study period
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
elective admissions to ICU (e.g. post-operative), glycaemia-related admission to ICU, pregnancy, major blood loss
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Study design
Purpose
Screening
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Duration
Cross-sectional
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
A statistician has undertaken a simulation analysis using a previous study on the stress hyperglycaemia ratio (SHR) to determine the sample size required for this study. Assuming an event rate of 15%, a sample size of 1200 subjects has 80% power to detect an independent association between SHR and mortality with an estimated odds ratio of 1.25 per 0.1 increase in SHR at the two-tailed 0.05 significance level. To ensure we have sufficient power, we will recruit 1400 subjects. We will perform univariate as well as multi-variate analyses to compare the SHR with other predictors of outcome in intensive care, including absolute glycaemia, APACHE III scores.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
27/01/2016
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Actual
27/01/2016
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Date of last participant enrolment
Anticipated
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Actual
1/04/2017
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Date of last data collection
Anticipated
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Actual
1/10/2017
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Sample size
Target
1400
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Accrual to date
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Final
1262
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
4385
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Flinders Medical Centre - Bedford Park
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Funding & Sponsors
Funding source category [1]
292112
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Government body
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Name [1]
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National Health and Medical Research Council
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Address [1]
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Level 1
16 Marcus Clarke Street
Canberra ACT 2601
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Country [1]
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Australia
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Funding source category [2]
292113
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Other
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Name [2]
292113
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Royal Australasian College of Physicians
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Address [2]
292113
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145 Macquarie St, Sydney NSW 2000
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Country [2]
292113
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Australia
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Funding source category [3]
292114
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Commercial sector/Industry
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Name [3]
292114
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Novo Nordisk Regional Diabetes Scheme
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Address [3]
292114
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Novo Nordisk Pharmaceuticals Pty. Ltd.
PO Box 7586
Baulkham Hills Business Centre NSW 2153
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Country [3]
292114
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Australia
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Funding source category [4]
292115
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Charities/Societies/Foundations
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Name [4]
292115
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FMC Foundation
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Address [4]
292115
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Flinders Medical Centre Foundation
Flinders Drive
Bedford Park 5042
South Australia
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Country [4]
292115
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Australia
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Primary sponsor type
Individual
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Name
Assoc Prof Morton Burt
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Address
Southern Adelaide Diabetes and Endocrinology Services
Repatriation General Hospital
216 Daws Rd, Daw Park SA 5041
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Country
Australia
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Secondary sponsor category [1]
290801
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None
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Name [1]
290801
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Address [1]
290801
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Country [1]
290801
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
293598
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Southern Adelaide Clinical Human Research Ethics Committee
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Ethics committee address [1]
293598
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The Flats G5 – Rooms 3 and 4 Flinders Drive Flinders Medical Centre, Bedford Park SA 5042
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Ethics committee country [1]
293598
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Australia
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Date submitted for ethics approval [1]
293598
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15/06/2015
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Approval date [1]
293598
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07/08/2015
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Ethics approval number [1]
293598
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AU/15/F77F18
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Summary
Brief summary
Hyperglycaemia in hospitalised patients is independently associated with increased morbidity and mortality in a wide range of patient groups, including the critically ill. The association between hyperglycaemia and poor inpatient outcomes is strong in patients without diabetes. However, despite a greater elevation in plasma glucose concentration and poorer prognosis, hyperglycaemia is a weaker predictor of morbidity and mortality in patients with diabetes. A high plasma glucose concentration in a hospitalised patient can occur because of chronic poor diabetes control and be “normal” for that patient, represent a transient physiologic response to an intercurrent illness (stress hyperglycaemia), or be a combination of the above. Stress hyperglycaemia arises because of the inflammatory and neurohormonal derangements that occur during a major illness. Therefore, stress hyperglycaemia develops in proportion to the severity of an intercurrent illness, and an association between hyperglycaemia and adverse patient outcomes will be, at least in part, a reflection of this. However, stress hyperglycaemia may also directly contribute to adverse outcomes by inducing endothelial dysfunction and oxidative stress. The Endocrine Research Unit, Southern Adelaide Diabetes and Endocrine Services recently developed a metric for stress hyperglycaemia. Estimated average glucose concentration was calculated from glycosylated haemoglobin in 2290 patients acutely admitted to Flinders Medical Centre, Adelaide. Relative hyperglycaemia was defined by the stress hyperglycaemia ratio (SHR), calculated by dividing admission glucose by estimated average glucose. Thus, a patient with a SHR of 1.5 has an admission glucose concentration 50% higher than their average glucose over the prior 3 months. Using data gathered from a research primarily focused on validating the use of HbA1c for diagnosis of diabetes mellitus, a multivariable analysis including glucose, SHR and other potential predictors of poor outcome (e.g age, sex, renal function), the odds ratio for in-hospital death or ICU admission per 0.1 SHR increment was 1.20 (p<0.001). In contrast, the odds ratio per one mmol/L glucose increment was 1.03 (p=0.31). In contrast to glucose, the association between diabetes and SHR was not affected by diabetic status. These data suggest that SHR is a better predictor of adverse outcomes than glucose and that SHR is associated with poor outcomes in patients with and without diabetes. In this study, we will evaluate whether SHR is more strongly associated with in-hospital mortality in critically ill patients than absolute glucose. If true, this may create a new paradigm whereby patients in ICU are selected for glucoselowering therapy based on relative, rather than absolute, hyperglycaemia.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Morton Burt
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Address
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Southern Adelaide Diabetes and Endocrine Services
Repatriation General Hospital
216 Daws Road,
Daw Park, SA 5041
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Country
60610
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Australia
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Phone
60610
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+61882751094
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Fax
60610
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Email
60610
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[email protected]
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Contact person for public queries
Name
60611
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Tien Lee
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Address
60611
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Southern Adelaide Diabetes and Endocrine Services
Repatriation General Hospital
216 Daws Road,
Daw Park, SA 5041
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Country
60611
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Australia
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Phone
60611
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+61455982828
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Fax
60611
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Email
60611
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[email protected]
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Contact person for scientific queries
Name
60612
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Tien Lee
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Address
60612
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Southern Adelaide Diabetes and Endocrine Services
Repatriation General Hospital
216 Daws Road,
Daw Park, SA 5041
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Country
60612
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Australia
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Phone
60612
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+61455982828
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Fax
60612
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Email
60612
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
Info collected are deidentified but due to the large amount of data collected on each patient in a single centre, it may be reidentifiable to specific patients. Ethics committee and approval will need to be sought and granted for specific requests prior to release of data.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Does hyperglycemia affect arginine metabolites in critically ill patients? A prospective cohort and in vitro study.
2023
https://dx.doi.org/10.1186/s13098-023-01035-8
N.B. These documents automatically identified may not have been verified by the study sponsor.
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