Michelle A. Kovalaske, MD; Gunjan Y. Gandhi, MD, MSc
Does intensive glucose control reduce 90-day mortality in critically ill adults?
Randomized controlled trial (Normoglycemia in Intensive Care Evaluation—Survival Using Glucose Algorithm Regulation [NICE—SUGAR] trial). ClinicalTrials.gov NCT00220987.
42 hospital intensive care units (ICUs) in North America, Australia, and New Zealand.
6104 medical and surgical patients ≥ 18 years of age who were admitted to an ICU within the past 24 hours and were expected to need ICU treatment for ≥ 3 consecutive days.
3054 patients were allocated to intensive glucose control (target blood glucose 4.5 to 6.0 mmol/L [81 to 108 mg/dL]) using intravenous insulin infusion; 3050 were allocated to conventional glucose control (target blood glucose ≤ 10 mmol/L [180 mg/dL]). Glucose control was continued until patients started eating or were discharged from the ICU.
Included 90-day mortality, 28-day mortality, and severe hypoglycemia (blood glucose level ≤ 2.2 mmol/L [40 mg/dL]).
99% (intention-to-treat analysis).
The main results are in the Table. Increased risk for 90-day mortality was similar (P = 0.10 for heterogeneity) in surgical patients (relative risk increase [RRI] 24%, 95% CI 6 to 45) and nonsurgical patients (RRI 5%, CI −5 to 16).
At 90 days, intensive glucose control increased risk for death and severe hypoglycemia more than conventional glucose control in critically ill adults.
Intensive vs conventional glucose control in critically ill adults†
†Abbreviations defined in Glossary. RRI, NNH, and CI calculated from data in article.
‡Blood glucose level ≤ 2.2 mmol/L (40 mg/dL).
Kovalaske MA, Gandhi GY. Intensive glucose control increased risk for death and severe hypoglycemia in critically ill adults. Ann Intern Med. ;151:JC2–5. doi: 10.7326/0003-4819-151-4-200908180-02005
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Published: Ann Intern Med. 2009;151(4):JC2-5.
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