Is Intensive Glucose Control Beneficial to Critically Ill Patients?
Is Intensive Glucose Control Beneficial to Critically Ill Patients?
NICE-SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al
N Engl J Med. 2009;360:1283-1297
Is tight glucose control a beneficial strategy for critically ill patients? The authors conducted a large multicenter, randomized controlled trial consisting of 6104 patients comparing intensive control (blood sugar between 81 and 108 mg/dL) with less strict, conventional control (blood sugar less than 180 mg/dL). About a third of the patients had undergone surgery. For the entire group, the overall mortality was 27.5% in the tight-control group compared with 24.9% in the conventional group (P = .02). Extremely low blood sugar levels were reported in 6.8% of the intensive-control group compared with 0.5% in the standard-care group (P < .001). No differences were found in any other variables, such as length of stay in the intensive care unit or duration of mechanical ventilation.
Hyperglycemia is a common event in critically ill patients; therefore, careful control of blood sugar would seem to be a beneficial strategy. Prior reports have yielded conflicting results. This large multicenter trial found that tight glucose control increased rather than reduced overall mortality. Excess mortality in the tight-control group persisted for a 3-month period. It is not surprising that severe hypoglycemia was much more frequent in the treated group. The take-home message from this robust trial: Tight glucose control is not a worthwhile strategy for critically ill patients.
Abstract
Intensive Versus Conventional Glucose Control in Critically Ill Patients
NICE-SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al
N Engl J Med. 2009;360:1283-1297
Summary
Is tight glucose control a beneficial strategy for critically ill patients? The authors conducted a large multicenter, randomized controlled trial consisting of 6104 patients comparing intensive control (blood sugar between 81 and 108 mg/dL) with less strict, conventional control (blood sugar less than 180 mg/dL). About a third of the patients had undergone surgery. For the entire group, the overall mortality was 27.5% in the tight-control group compared with 24.9% in the conventional group (P = .02). Extremely low blood sugar levels were reported in 6.8% of the intensive-control group compared with 0.5% in the standard-care group (P < .001). No differences were found in any other variables, such as length of stay in the intensive care unit or duration of mechanical ventilation.
Viewpoint
Hyperglycemia is a common event in critically ill patients; therefore, careful control of blood sugar would seem to be a beneficial strategy. Prior reports have yielded conflicting results. This large multicenter trial found that tight glucose control increased rather than reduced overall mortality. Excess mortality in the tight-control group persisted for a 3-month period. It is not surprising that severe hypoglycemia was much more frequent in the treated group. The take-home message from this robust trial: Tight glucose control is not a worthwhile strategy for critically ill patients.
Abstract
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