Aggressive glucose control in critical illness seems to increase mortality, according to a New England Journal of Medicine study released online.

Investigators in the NICE-SUGAR trial attempted to define the best glucose target range by randomizing 6100 medical-surgical ICU patients either to intensive control (81 to 108 mg/dL) or to conventional control (180 mg/dL or less) with use of intravenous insulin. Death by 90 days (the primary outcome) occurred more often with intensive control than with conventional therapy. Intensive control also led to more episodes of severe hypoglycemia (blood glucose, 40 mg/dL or less).

The authors estimate a number needed to harm of 38.

Editorialists point out that the NICE-SUGAR results “contrast starkly” with earlier trials. Their take on the study’s lessons is that “there is no additional benefit from the lowering of blood glucose levels below the range of approximately 140 to 180.”
LINK(S):

NEJM article (Free)

NEJM editorial (Free)

Physician’s First Watch coverage of intensive insulin therapy in the pediatric ICU (Free)

Published in Physician’s First Watch March 24, 2009

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