Endocrinology in critical care · Glycaemic control in critical illness
Intensive versus conventional glucose control in critically ill patients
| Design | Large international randomised controlled trial |
|---|---|
| Treatment | Intensive glucose control targeting 81 to 108 mg/dL |
| Control | Conventional control targeting 180 mg/dL or less |
| Population | 6104 critically ill adults: 3054 intensive and 3050 conventional |
| Follow-up | 90 days |
| Primary endpoint | 90-day all-cause mortality |
| Result | Intensive glucose control increased mortality among adults in intensive care compared with a target of 180 mg/dL or less. Severe hypoglycaemia was far more frequent with intensive control. |
| Secondary endpoints | Severe hypoglycaemia, ICU and hospital length of stay, organ support |
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.
The trial authors, in the published abstract
One of the clearest reversals in critical care, overturning the Leuven trials and the guidelines built on them. Severe hypoglycaemia is the plausible mechanism, and the episode is a standing warning about generalising single-centre physiological successes.
Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009 Mar 26;360(13):1283-97.