Blood glucose control for ICU patients

NEJM Article (Sept 20, 2012)

Hypoglycemia and Risk of Death in Critically Ill Patients

In critically ill patients, intensive glucose control leads to moderate and severe hypoglycemia, both of which are associated with an increased risk of death. 

Understanding Low Sugar from NICE-SUGAR (Commentary):

Given the current stage of evolution in inpatient insulin therapy, what are the best glucose targets for patients admitted to the ICU? In many hospitals, maintaining blood glucose at levels similar to those in the conventional-control group of the NICE-SUGAR population is safe and similar to other recommendations (140 to 180 mg per deciliter).

Key Points:

• ICU patients were randomized to intensive (target BS 81-108 mg/dL) vs conventional (target BS 180 mg/dL) blood glucose control.
• Mean BS in intensive control gp = 115 mg/dL vs conventional gp = 144 mg/dL
• Intensive control gp had 2.6% absolute increased risk of death in 90d vs conventional gp (NNH = 38). 
• Moderate hypoglycemia (blood glucose level, 41–70 mg/dL) was significantly more common in the intensive-control group than in the conventional control group (74% vs. 16%). 
• Almost all (93%) of the 223 patients who experienced severe hypoglycemia (blood glucose level <40 mg/dL) were in the intensive-control group. 
• Hypoglycemia was associated with longer ICU stay, longer hospital stay, and mortality. 
• Patients with worse outcomes included those who experienced more than one episode of hypoglycemia and those with severe hypoglycemia despite not having received insulin (reflecting that hypoglycemia can result from severe illness). 
• The adjusted hazard ratios for death were 1.41 in patients with moderate hypoglycemia and 2.10 in patients with severe hypoglycemia.