Topic
Endocrinology in critical care
Glycaemic control in critical illness.
What the evidence shows
Tight glucose control kills. Intensive insulin therapy targeting normoglycaemia increased mortality compared with a target of 180 mg/dL or less, with far more severe hypoglycaemia (NICE-SUGAR). It had become standard on the strength of single-centre trials whose own authors were careful about their limits: the benefit appeared only in patients treated three days or more, and those patients could not be identified in advance (Van den Berghe 2006).
The episode is the field's clearest warning about generalising physiological success from one centre to the world.
Glycaemic control in critical illness
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| NICE-SUGAR | 2009 | Intensive insulin therapy | Tight glucose control killed people; a target of 180 mg/dL or less was safer | |
| Van den Berghe 2006 | 2006 | Intensive insulin therapy | Tight glucose control reduced morbidity but not mortality, and the responders could not be identified in advance |
Key references
Guidelines, standards and reviews for this topic.
- Intensive insulin therapy
- Hartl WH, Elke G. Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU. N Engl J Med 2023 Dec 7;389(23):2207. PMID 38055263