Clinical question: Does intensive glucose control reduce mortality at 90 days in adult ICU patients?
Background: The American Diabetic Association currently recommends tight glucose control for patients admitted to an ICU, despite conflicting evidence in the literature about the benefits of this practice.
Study design: Randomized controlled trial.
Setting: Medical and surgical ICUs at 42 hospitals in Australia, Canada, and New Zealand.
Synopsis: More than 6,000 medical and surgical ICU patients were randomly assigned to receive either intensive (target blood sugar range of 81 mg/dL to 108 mg/dL) or conventional (target blood sugar of <180 mg/dL) glucose control. Eligible patients were expected to stay at least three days in the ICU. Mortality at 90 days for the intensive treatment group was 27.5% versus 24.9% in the conventional treatment group, with an absolute difference in mortality of 2.6% resulting in a number needed to harm of 38.5. This difference in mortality remained significant whether the patients were in a SICU or MICU, diabetic or nondiabetic, with or without sepsis, and with APACHE II scores of above or below 25. The excess deaths were attributed to cardiovascular causes, but more investigation is needed. This study demonstrates that there is no additional benefit and that there may be harm in pursuing aggressive glucose control in ICU patients.
Bottom line: When compared with conventional practice in adult ICU patients, intensive glucose control resulted in an increase in 90-day mortality.
Citation: NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297.