Tuesday March 31, 2009
So now is intensive glucose control bad?

Background: The optimal target range for blood glucose in critically ill patients remains unclear.
Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either

• (3054 patients) intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or
• (3050 patients) conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter)

The two groups had similar characteristics at baseline.

Primary end point: Death from any cause within 90 days after randomization.

Results:

• A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (P=0.02).
• The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (P=0.10).
• Severe hypoglycemia (blood glucose level, less than/=40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group.
• There was no significant difference between the two treatment groups in the median number of days in the ICU (P=0.84) or hospital (P=0.86) or the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39).

Conclusions: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter.



Reference: click to get abstract

Intensive versus Conventional Glucose Control in Critically Ill Patients - NEJM, March 26, 2009, Volume 360:1283-1297 , Number 13